IDAS Forms REC17/0013

                                                                               Department of Infrastructure. local Government and Planning


5.         Are there any current approvals           (e.g. a preliminary    approval)   associated   with this application?      (Non-
           mandatory requirement)
       ,
G' No              D      Yes-provide    details below


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



6.         Is owner's   consent   required for this application?           (Refer to notes at the end of this foom for more information.)

D No
[if' Yes~omplete           either Table F. Table G or Table H as applicable

Table F

Name of ownerls of the land

IMle, the above-mentioned         ownerls of the land, consent to the making of this application.

Signature of ownerls of the land


Date

Table G

Name of ownerls of the land                   I
D The owner's written consent is attached or will be provided separately to the assessment manager.
Table H

Name of ownerls of the land               T
D By making this application, I, the applicant, declare that the owner has given written consent to the making of the application.
7.     Identify     if any of the following        apply to the premises      (Tick applicable box/es.)

g Adjacent to a water body, watercourse or aquifer (e.g. creek, river, lake, canalHomplete                          Table I

D      On strategic port land under the Transport Infrastructure A~i'1994--{:ompleie                 Table J

D      In a tidal water area~omplete              Table K

D      On Brisbane core port land under the Transport Infrastructure Act 1994 (No table requires completion.)

D      On airport land under the Airport Assets (Restructuring              and Disposal) Act 2008 (no table requires completion)

D      Listed on either the Contaminated Land Register (CLR) or the Environmental                    Management      Register (EMR) under
       the Environmental Protection Act 1994 (no table requires completion)

Table I

Name of water body, watercourse or aquifer

     t-Aks- ON ~OOSA. SPR1~C:tS GrOL-PCO~.("Z)


                                                                                                               IDAS form 1-Application de/ails
                                                                                                                Version 4.3-5 December 2016