Application for permit to damage vegetation - OPW13/0074

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         Table F~p}emises coordinates (Appropriate for development in remote areas, over part of a lot or in water not
         adjoining or adjacent to land e.g. channe dredging in Moreton Bay.) (Attach a separate schedule if there is insufficient
         space in this table.)

         Coordinates                                                        Zone          Datum                 Local government
         (Note: place each set of coordinates in a separate row.)           reference                           area   (if applicable)
         Easting       Northing         Latitude          Longitude
                                                                                                            ,




                                                                                          0 GDA94
                                                                                          0 WGS84
                                                                                          0 other
        4. Total area of the premises on which the development is proposed (indicate
                                                                                              square metres)




        5. Current use!s of the premises (e.g. vacant land, house, apartment building, cane farm etc.)


              VIrCA"’~     t.1t"! P



        6. Are there any current approvals (e.g.a preliminary approval) associated with this
                                                                                                       application? (Non-
        mandatory requirement.)

        rr No          o     Yes-provide details below

        List of approval reference/s                     Date approved (dd/mm/yy)               Date approval lapses (dd/mm/yy)




        7. Is owner’s consent required for this application?
                                                                (Refer to notes at the end of this form for more information.)

        o     No


        Ga’ Yes-complete either Table G, Table H or Table I as applicable

        Table G

        Name of owner/s of the land
                                               :Ji.
                                                  ;;-REI/ C.           +   t//   J’::O/V’E         &-E#.tE/Z
        I/We, the above-mentioned owner/s of the land, consent to the making of this
                                                                                        application.
    Signature of owner/s of the land               //1. tM                              (.~
                                               ff//
                                                    ’

    Date                                     1//
                                                1/2/17                                       ’/2-/r3
    Table H

    Name of owner/s of the land


    o The owner’s written consent is attached or will be provided separately to the assessment
                                                                                                        manager




I   Table I

    Name of owner/s of the land


    4
                                                                                                       IDAS form 1-Application details
                                                                                                        Version 2.017 December 2012