0015E664.001

.      INTEGRATED PLANNING ACT 1997                                                         :                                  Part A, Version 2,4, 29 May 2006
             ‘Land owner's consent (if applicable)’ “’ *) 20.: Land owner’s.consent'to thie tmiaking of this application:   ee.                    ES
             ‘application must contain, or be supported by, the |              Name                                   Signature             | Date          |
             written consent of the land owner/s, if the epplication J ‘                       “
             J      a       -      .     .        vo            I
             (i), reconfiguration.of a sot; :
             (Ti) work on land below high-water mark & not withinal =f (ii FY /         {n>
             x. -. canal as defined under the Coastal Protection and if) PHIL        BpcoN | boone ee ee                  ec eee eee          e fee e cece eee eee dd”
             '.. Management Act 1995;0                          es
             ‘(v) work on rail corridor land defined under the + (iii)                                                                                            .
             -.. Transport infrastructure Act 1994..   .      wea       eee ee eee ee eee eee eee bec eee ee ee eee          eee c nec ee ececee feeeccennceece
             Section 3.8.1(2)(a) of the IPA provides that       .
             Flandawner’s consent is pot required for a mobile or (iv)
             ‘temporary ERA .            a    soe             we ee ene ene eee eee a be nee ce eee naan nnn we cece etc een ence none ene
            [fameemate tr Si                                 |
       *     fResource entitlement (applicable)       | 21.  Does this application involve'a State resource prescribed under a regulation (other then involving’
            [ Secon 3.2.15) of to IPA rogues evidence o     quany         ‘on State coastal land under the Coastel Protection and Management Act 1995)?
        ‘    rresource entitlement be given for applications that WhO sot     es,                    ey                        .    Bo                     Je,
             Involve a prescribed State respurce.                  O - goto Q24            ae        Ee] YES-igoitoQ22..                      BO     se es
             Section  3.2.1(1      IPA prescribes               i                                    Tee an                           .        ee,
       |    trp       amt ten be opty mse” -|22.             This appicaion is aocompanied by evidence: (ck apiabie bos)                      oN
             ‘without evidence of the resource entitement     1 (i - of the:allocation of, or enititlement to, the fesource - attach:     and goto.Q23(u)
            | Refer to schedule 10 of the integrated Planning (C1 (ii) the chief executive'of the department administering the seSource is satisfied the. -
             Regutation 1998 that prescribes the nature of evidence                1s consister        an    allo      of.   or.entitiement to, the resource -
            ered by the State in support of the lodging of this     : development is consistent with an allocation. con sistent with-an allocation of, oF ntitlement to, the resource : 92
            F                                   -,    |  +, CA) (il); the:chiefexecutive of the:department administering the resource is satisfied the     .
             mo   ,                                          '_.   + development:application may proceed in the absence of an allocation.of; or.”            —
                                                    .             " -entitement to;-the resource-gotoQ23.           4%,                         ye
             :    .                                       .           TPR        La      he                      Te           ok           :     eee
            Ace forcommieina ge               evidence \22 FWidence ofthe tesource entitement,.§                                          2     OMe,
             regifed under G22 i) (i) above.” oviene'S |     (i), Resource entitlement’ aiithority details:   <<:       (vii) Official stamp of the department:
             “The offcial stamp of the Department of Natural                                                       :.    *" administering the resource (it,
            ; Resources, Mines and Water is mandatory where the Se                                              rer         applicable) -            ss
             -application Involves any water or riverine quany - (ii) Name:of delegated officer -             wets
            te a                                       eel         L______2__]
            {Secon 32.(6A) allows,the resource manag f im pe   tel                __ Tia          —             a.                                             :
             .the time the evidence ‘may be used. must be    ‘i        ition of deleaated.  officer 7h"   wk
            [completed ifthe evidence i Hime limited.        (iii) Position:of delegated.dfficer   “."i         we
           t.                                    _  |      > (iv) * Sighature of delegated officers? FO       AF

            f                                                (v)   Date’)                Te
             :      .                    ;                        -/7                                              4
             i                                        +      (wi! i Set tenets epee                      Se                     ke               ig
            | Assessment triggers                       24. i     OAS hese             Checklist completediand attached to this application? ©. 2"
         _   This checklist does pot apply if the application requires ey                   ay    we     aa     BT                        EE    a etM oi
             ‘the completion of Parts A and 8 of the Form only, “It . YES Tet aM Be -L.3'NO.- ite assessment manager may refuse to accept this app lication on fhe
         Sette camped fora ober appears.              |                      ER TL               nnd tat the appletion hes not been propery made
            tPlans { drawings / reports                 125. ‘Plans/drawings/reports accompanying this application:             wn ee EEE                                .
                                  eee                     “[__PantOrvng/Repotnonter                        [Te | Oa]
             sManager, referral agencies and any person viewing ay              ,
             the application during public scrutiny or public , (i)            *     10                                                          O-   |
           een                     conr eee                     200%! MOL. New. Seta. SuaP.| OF/OF |
            a                                          ‘       (ii)  °°    .                 .    '          1            -                                    :
             :                                  oo             0)         copies                eld
                 .          ;           nt oe              LW)                           __                                                              :    |
             PLEASE NOTE: Tie assessment manager may refuse to'accept an application that, .af the tiie of lodgement, fails to provide all applicable information required by Part A
      .                        - and any other relevant part of Form 1.                        ,        '
                  rrr errr                                                                                    A a a
             OFFICE USE ONLY (applicable to assessment manager's)                             Zz
             Rem      Ges             bl   vane               l6lo7                      Mets |        > Xan               |Snimeene 167] 1 52-9
             .                                       Notification of Engagement of Private Certifier.(Optional forma}                Poa                  ee
                                                                 :       :    .          as       eT               8        .
.             To.                                                    Council, | have been engaged as the private certifier-for the building work referred to in this application:
              Date ofengagement    /   /    Accreditation Number                     Name                               Signatres