00157AD5.001

INTEGRATED PLANNING ACT 1997                                                                                              Part A, Version 2.4, 29 May 2006
               Land owner's consent (if applicable)      20.   Land owner's consent to the making of this application:
              Splcon rust cnt oo Sppr oy.                      |                 Namo                                   Signature                 |      ate
               application must contain, or be supported by, the                                                          Signature                      Date
              written consent of the land owner/s, if the application                                                  ,                              S
              involves:                                           I                                                                                     o
               (i) reconfiguration of a lot; mak 8 notwtthi     (i
               (i)  work on tand below high-water no   a          ii
                 Canal 3s defined under he Coastal Protection and Rone                EXCO                  | Zo   aan          SemeeZ_ (33-297.
                  Management Act 1995:0r                          ove
               (¥) work on rail corridor land defined under the  (ii)
                  Transport Infrastructure Act 1994.            eee cece n acer n ee cena na ner cneen ewe nnceb nace eeu aecnca encase e cence ene bere mnneenecee
               Section 3.8.1(2){a) of the IPA provides that       .
               landowner’s consent fs pot required for a mobile or (iv)
               temporary ERA .                                  in nn        ne       nn       ee eb ae ee ee ee                     eet eens beeen eee nen
               For more Information refer io Guide 1,            (v)
               Resource entitlement (if applicable)      21.   Does this application involve a State resource prescribed under a regulation (other than involving
               Section 3.2.1(5) of the IPA requires evidence of Who         on State coastal land under the Coastal Protection and Management Act 1995)?
               Fasource entitlement be given for applications that
              InvoWve a prescribed State resource.                NO - go to 024                        (1 YES - go te 022
               Se   nioe annette Serotemostesse          22.   This application is accompanied by evidence: (tick appicable box)
                 we nee of ne rae enttement,                   [1 (i)  of the allocation of, or entitlement to, the resource - attach evidence and go to 023(v)
              Refer to schedule 10 of the /ntograted Planning  (J (ii) the chief executive of the department administering the resource is satisfied the
               Regulation 1998 that prescribes the nature of evidence                         i        j              ;             7                         _
                      ty the =i  suppon of the ldgng of ths           devetopment is consistent with an allocation of, or entitlement to, the resource ~ go
               development      i.
                                                               (1) (iii) the chief executive of the department administering the resource is satisfied the
©                                                                      development application may       proceed in the absence of an allocation of, or
                                                                       entitlement to, the resource — go to 023
               Adve for completing "28       '       _ | 23.   Evidence of the resource entitlement:
               required under on th eve    9         ‘         (i)  Resource entitlement / authority   details             (vii) Officia! stamp of the department
              The official stamp of the Department of Natural                                                                  administering the resource (if
               Resources, Mines and Water is mandatory where the .                                                             applicable)
               application involves any water or riverine quarry (ii) Name of delegated officer
               sen tr                                               Td
               Section 32.164) allows the ee Oe to limit
               the time the evidence may be used. vi} must be  iil      ity
               completed t Pe      petal                      (iii) Position of one       officer
                                                              (iv)  a of ~ officer
                                                               (v)  Date
                                                              (vi)  _ date of evidence ‘ —
  ©            Assessment triggers                       24.  is the JDAS Assessment Checklist completed and attached to this application?
               This checklst doe     tf the application requl  ay                                                                                    _
               the completion of sagt epphy Botte Fom ony it        ES                     (1) NO - the assessment manager may refuse to accept this application on the
               must be completed for ait other applications.                                         grounds that the application has not been property made
               Plans / drawings / reports                25.  Plans/drawings/reports accompanying this application:
              Manager, referral agencies and any parson viewing   .     -                             Sd
              the application during public scrutiny oF public   )     DEL                             LOVE          BA/
               and any potential Impact.                         (ii)
                                                                 {iii)
                                                                 (iv)
               PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide all applicable information required by Part A
                                 and any other relevant part of Form 1.
              a
              OFFICE USE ONLY (appiicabie to assessment manager's)
               ee                        | ete |S ee
                                                RECEIVED                               NAME/S                                     NUMBERIS
                                                       Notification of Engagement of Private Certifier (Optional formal)
                To                                                    Council. | have been engaged as the private certifier for the building work referred to in this application.
                Date ofengagement    /   /    Accreditation Number:                 ___ Name:                              Signature: