IDAS Form-1-application-details -signed

‘ep ee

   

Sara ee RS SS

Table K

 

 

 

 

Name of local government for the tidal area (if applicable)

 

  

Port authority for the tidal area (if applicable)

 

 

  
       

    

we

 

(Son the p

 

 
 

 

 

 

[.] No WM  Yes—ensure the type, location and dimension of each easement is included in the plans submitted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

im Yes—complete Table L and submit with this application the yellow local government/private certifier’s copy of the
receipted QLeave form

Table L

Amount paid

 

Date paid
(dd/mm/yy)

 

QLeave project number

(6d
starting with A, B

, E, Lor P)

 

 

 

 

 

 

 

M No

 

[_] Yes—please provide details below

Name of local government

Date of written notice given

by local government
(dd/mm/yy)

 

Reference number of written notice given
by local government (if applicable)

 

 

 

 

 

 

IDAS form 1—Application details

Version 3.0—1 July 2013