07/1842 - MCU - Detached House [As Published] · 132007.1842

Part A, Version 2.4, 29 May 2006

 

 

The completion of all applicable questions on Part A is mandatory for all applications. Part A must be accompanied by the completed IDAS Assessment Checklist if
required, and by one (1) or more other completed parts of the Form as required. For more information on the parts of the Form refer to www.ipa.qid.gov.au.
Any information requested in the form may be provided in an attachment to the application. For further information about completing the following details, refer to Guide 1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description of land 1. Street address: fncludinghouse number, street name, suburb/ocality name & postcode) (if applicable)
Alltand the subject of the application, must be .
identified. However, a description ofthe land is not | 436 La Ke. Flot Road . Roreew i ‘ Q LA “SES
required in relation to a mobile or temporary 2. Name of water body or watercourse, within which the development is proposed: (if applicable)
Environmentally Relevant Activity (ERA). ry
Advice for completing Q2 - Q2 applies if hoes} RPS ORO
development is proposed within a water body or b — si -
watecourse. 3. Lot on plan description (eg. Lot 123 on RP 4567) / GPS coordinates:
Advice for completing Q3 - Most land can be P i
@ for coms ri . land can ~~
identified by a lot on plan description, These details | lot ] on R.P PS2 C20 |
be obtai tle d ts oF through Ce
Iowal pana mn file documents or hrough he | 4 The above description is for: (tick applicable box)
However, if the land on which the development is i) the land on which the development is proposed; or
proposed does not have a tot on plan description (ie. p
the develooment is proposed in a water body or ~ Ci (ii) the land adjoining the water body or watercourse, within which the development is
watercourse} provide — proposed; or
i iption for th fe
0 pe ean ariba aiid ° D (ii) the water body or watercourse.
ii) GPS coordinates where there i
" adiciningadiacent Tan (eg. In Moreton Bay). 5. Shop / tenancy number: 6. Storey / level: 7. Total area of land: (nm? or ha):
Advice for compteting Q? - Q7 does not apply if the
development is within a water body or watercourse. | } LL | 2 3, & hae
Advice for completing Q8 - 08 applies if q . ie gj . a
developments within a local government area, 8. Local government area in which the land is situated: (eg. Esk, Hervey Bay, Woocoo etc.) (if applicable)
Note: Areas below high water mark af pat within a [ Fa rich of NOOSE, |
government's area untess provid under T
Local Government Act 1993. 9. Port authority for the strategic port land or strategic port land tidal area on which the
Advice for completing Q9 - Q9 applies if i . 5 oy re -
Geveloomantis on stelegic pot land ora strategic development is proposed: (eg. Port of Brisbane, Port of Townsville) (if applicable)
port land tidal area, For mare details refer to Guide 11 [
Proposal details 10. Existing use of the land: (eg. vacant, single house, shop etc.)
If there is insufficient room available, details may be
provided in an atiachment to the appleation. L ke Ef. C4 ne
11. Proposed use of the land: (eg. 6 unit apartment building, 30 lot residential subdivision, ERA for aquaculture in
Pp
ponds with @ total area of 7 ha for which wastes are released into waters etc).
[_ svhgle le steukjee  Awellyy
t
Other applicable parts of Form 1 12. Other parts of Form 1 completed as part of this application: (eg. Part D, Part I, etc)
Part A must always be accompanied by other [
completed parts of Form 1. Far information about
when a part of Form 1 may apply refer to Guide 4.
Applicant details 13. Applicant's name: 15. Contact person:
Clearly identify who is making the apptication. The
applicant need at be the owner of the tand. c § eek if ws | ele el
When signing and lodging this application 14. Contact number: 16. Facsimile number/e-mait address:
The applicant is responsible for ensuring the _
information provided is correct. The assessment | 0? 326 g 2 JO 9 |
Tanages, any referral agency & the Chief Executive .
{where applicable) wil rely on this information when | 17. Postal address:
assessing and deciding the apptication. ~
the applicant is a company - a contact person | S4& David Ave j2QId ow QL 4045 |
‘must be shown. 18. Signature: 19. Date:
( FALOF
Joka / | #222

 

 

 

 

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