09/1530 - MCU - Detached House [As Published] · 132009.1530

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INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008

 
  
 

Part A

Common details

 

 

 

 

 

 

 

 

   

 

 

 

 

 

 

 

 

 

 

 

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ivi ii f 2 (FE one: appl fails on en attachment to this form) |
Title Firstname Te Off WV Last name Hfoek
— -|Rostal address: «=. [Po Box-1054.-- MAROOCHYDORE—O:455B=crsrazs ome oon = crannies eaten <n] . ore .
: —— 4
Contact telephone number (07) 5443 7288 , Mobilé.phone number : i
Facsimile number (07) 5443 8816 é-mail address [email protected] :

 

 

 

 

1. Identify the premises by completing Table A, or Table B and/or Table c (ensure adequate information is given to identify the premises)
Table A Ifthe application is for a mobile and temporary Environmentally Relevant Activity (ERA), complete Table A only. Then go to Q2.

 

   
    

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OR
TableB Street address for the premises (tick applicable box/es below and insert property description in the table. Identify each lot in a separate row.)

) [J Street address / lot on plan for the premises (Appropriate for most applications including building applications), or

(i) (] Street address /lot on plan for the land adjoining or adjacent to the premises (Appropriate for development in water e.g. jetty,
pontoon etc) (Note: Loton pign details may be obtained from tite documents, a ‘Rate’ notice, or from the focal government.)

Lawnvilte Rd Cooroy 4563 23 SP 199350 Noosa

 

ANDIOR
TableC Coordinates and/or a map of the premises (Appropriate for development in remote areas, over part of a tot, in water (e.g. channel dredging in Moreton
Bay) etc.)

["] vevasa

CO weses
[J Other-

 

2. Mentify if any of the foitowing apply to the premises by completing Tables D, E, or F.. (Note: in most instances, the premises wil not involve any of
the following characteristics, however some applications may involve one or more of these characteristics - complete only if applicable)