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

1 TableD Complete if the premises are adjacent to or associated with a water body, watercourse or aquifer (eg. river, creek, lake, canal)

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Table E Complete it the premises are on Strategic Port Land under the Transport Infrastructure Act 1994

 

  

 

[1

 

 

 

 

 

 

 

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)

 

 

(1m? & hectares (Tick applicable unit)

 

 

 

 

 

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

 

 
 

[1 | Vacant Land . . —_ : ‘|

'§. Are there any existing easements on the premises? (e.g. for vehicular aécess, electicity, overtand flow, water etc)?

     

Ki No oO Yes - Ensure the type, location and dimensions of each easement are included in Plans, submitted with the application
‘Proposal: "de : : : G

6. Brief description of the proposal (e.g. 6 unit apartment ouilding, 30 fot residential subdivision, a bore, aquaculture)

  

 

New Dwelling

 

 

 

7. Does the poposal include new buildings or operational-work (including any services) on the premises?

{1 No x Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application

 

 

8. Does the apnlicaton involve taking or interfering w ‘with a a State resource and therefore t 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.)

4] No -Gato.a9 OC 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 to answer O9 - go to the next section.

 

9, Complete Table H for applications involving a material change of use; reconfi iguration of a lot work on land below high- -water mark and
aot 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. of on an attachment to this form if applicable.

 

TableH

 

 

 

 

 

 

 

 

 

 

* 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
attadament containing appropriate written documentation of the owner's consent. if the owner is a company, 3127 of the Corporations Act 2001 (Cwealth) details how a
company may sign as owrier. Templates for the provision of owner's consent are available on the IPA website .

 

 

  
 

 

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