001A7F18.001

“       Q INTEGRATED PLANNING ACT 1997                                                                                     Part A, Version 3.1,3 March 2008
                                 RomIOacoumtAydteciion                                                                                fe

          NOTE: Answer all questions unless directed to go to a particular question. Refer to the end of the form for advice on how to complete this form.
          ‘Applicant details (The Applicant is he person responsible for making the application afd need fot be the owner ofthe fand. The Applicant is responsible for ensuriig the |
          {information provided on the IDAS Application Form is correct. This information is relied upon by the Assessment Manager and any referral agencies when assessingand; |. -4
          [cing this applicatidn. By lodging this application; the Applicant incurs the: obligations and responsibilities prescribed:by the IPA, Any development permit of preliminary >
          {approval that may be issued as a consequence of this application wil be issued to thie Applicant). mss snmenamasianenenonmin een eee we ff
             Company/organisation name (if applicable) |                                                                                             .
          Individual applicant/Contact person (if there is more than one applicant, provide additional applicant details on an attachment to this form)
             Title          [hr         '| First name   [Alan                                   Last name      [Hendrick                             :
              Postal address               (cr. Max Watterson & Associates     PO Box639     COOROY       Q   4563
    S         Contact telephone number     [5442 6121                          | Mobile phone number            [oase 195 825
             ‘Facsimile number             [5442 5125                            e-mail address                [[email protected] au             |
          Details of the “Premises (.é. the land on'which the development is proposed, : refer to the advice at the end of the form)... sss, ek
           1.  \dentify the premises by completing Table A, or Table B and/or Table C (ensure adequate information is given to identify the premises)
           Table A   {f the application is for a mobile and temporary Environmentally Relevant Activity (ERA), complete Table A only. Then go to Q2.
          [2                               Narn of each local government area jn. which the mobile and temporary ERAS proposed to'operate’ =<
           OR
           Table B   Street address for the premises (tick applicable box/es below and insert property description in the table, Identify each fot in a separate row.)
                  (i) {[] Street address / lot on plan for the premises (Appropriate for most applications including building applications); Of
                  (ii) [_] Street address ot on plan for the land adjoining or adjacent to the premises (Appropriate for development in water e.g. jetty,     .
  ©                        pontoon etc) (Nate: Loton plan details may be obtained from title documents, a ‘Rate’ notice, or from the focal government.)      :
                            a? SI                                                             eaten Ce - tkoéal government area (e.g. Logen;ws}
                 C1 [fe               [oersica eesti                              fess srony
                 [2 |_| [ean i es                                               rr _[+                [sere
                      5 [fr [omnsiea necateee ——                                 [ar[_[ soon
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