09/0152 - MCU - Mulitple Housing Type 1 - Relative or Employee [As Published] · 132009.152

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INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008
Table D Complete if the premises are adjacent to or associated with a water body, watercourse or aquifer (e.g. river, creek, fake, cana)
Name of water body, watercourse or aquifer (if known)

 

 

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Table E Complete if the premises are on Strategic Port Land under the Transport Infrastructure Act 1994
Lot on plan description for strategic port land Port Authority for the lot
[1

Table F Complete if the premises are in tidal water
Name of local goverment for the tidal area (if applicable) Name of port authority for the tidal area (if applicable)
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3. indicate the total area of the premises on which the development is proposed: (Note: The total area may include land both above and below water)

 

 

 

 

 

 

 

 

 

 

: : Total area of premises

 

10.98 Cm &) hectares (Tick applicable unit}

 

 

 

 

iExisting use use of the the premises

4. Current use/s of the premises: (e.g. vacant land, house, townhouses, apartment building, shop, service station, schoo) sugar cane farming etc.)

 

[1 [Oweting & Ancilary Structures |

 

5. Are there any ee easements on the premises? (e.g. for vehicular access, electricity, overland flow, water efc.)?

O No 2d Yes - Ensure the ‘ype. Jocation and dimensions of each easement are included in plans. Submitted with the application e

 

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‘Proposal detai det WS er we
6. Brief description of the proposal (eg 6 unit apartment building, 30 lot residential subdivision, a bore, aquacuiture)

 

   

 

Annexed Dwelling Unit (Relatives Apartment)

 

 

 

7. Does the poposal include new buildings or operational work (including any services) on the premises?
Ol No X) Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application

 

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‘Resource entitlement (fapplicable) _- further information fs provided in the advice section at the end of the form

8, Does the application involve taking or interfering with a State resource and therefore require a resource entitlement? (e.g. the application
involves State land (leased and freehold), declared Fish Habitat areas, taking quarry material, taking or interfering with water under the Water Act 2000, etc.)

X No - Goto ag Oo Yes - Complete Table G - provide details for each evidence required on a separate row, if applicable. Evidence of resource
allocation or entitlement must be submitted with the application. You do not need fo answer Q9 - “9 to the next section,

 

iOwner's consent (if. applicable) | - further information is provided in the advice section at the end of the form, ou _ i

9. Complete Table H for applications involving a material change of use; reconfiguration of a lot; work on land below high- -water mark and
not within a canal as defined under the Coastal Protection and Management Act 1995; or work on rail corridor land defined under the
Transport Infrastructure Act 1994 - provide details for each owner on a separate row, or on an attachment to this form if applicable.

 

 

 

Premises Owner's name/s Details of the premises owned . . Date consent
Table H and postal address (street address or lot on plan description) Owner's signature’ was obtained
1 Robert & Debra Hammersley | 61 Lake Flat Road Boreen Point 28/01/2009

 

 

 

 

 

 

 

* Owner's signature cannot be provided on the form if you intend to submit the application electronically. Owner's consent must be provided to the assessment manager on an
attachment containing appropriate written documentation of the owner's consent. If the owner is a company, $127 af the Corporations Act 2001 (Cwealth) details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .

“attachments and supporting information (Complete Table | - Use a separate row for each type of atachment or information, including information ‘required j
“under this Part} Pioase ¢ ensure al af! documentation submitted | with this form, ackuding other Parts of Form 1, oF owner's consent, etc, are securely attached to this Part of the Form.

 

 

 

Description of attachment or information Title 6 Method of deli
applicable) of delivery to
Table | (9g. Part nC i Alilid ale bepsa aceane ; (e.g. General Authority, James Street Traffic Report} Date assessment manager
1 IDAS Form 1 Parts A, D & 03/02/2009 | mail

 

2 IDAS Assessment Checklist 03/02/2009 | mail