DNA 102 - Chnage develoment approval [As Published]

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008

2. — Identify if any of the following apply to the premises by completing Tables D, E, or F. (Note: in most instances, the premises will not invotve any of the
foltowing characteristics, however some appfications may involve one or more of these characteristics - complete only it applicable)

Table D Complete if ihe premises are adjacent to or associated with a water body, watercourse or aquifer (e.g. river, creek, lake, canal)

 

 

 

 

 

 

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Table F Complete if the premises are in tidal water

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4, Current use/s of the premises: (e.g. vacant land, house, townhouses, apartment building, shop, service station, school, sugar cane farming etc.)

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5. Are there any existing easements on the premises? (e.g. for vehicular access, electricity, overland flow, water etc.)
ero. oO Yes - Ensure the type, location and dimensions of each easement are included in plans, submitted with the application

 

 

 

 

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6. Brief description of the proposal: (e.g. 6 unit apanment buiing, 30 lot residential subdivision, a bore, aquaculture etc. )

 

 

 

 

7. Does the proposal include new building work or operational work {including any services) on the premises?
fs Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application

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8. Does the application involve taking or interfering with a State resource and therefore require a resource entitlement? (e.g. the application
involves4State land (leased and freehold), declared Fish Habitat areas, taking quarry material, taking or interfering with water under the Waler Act 2000, etc.)
0 - Go to 9 oO Yes ~ Complete Table G - provide details for each evidence required on 2 separate row, if applicable. Evidence of resource allocation or
enilement must be submitted with the application. You do not need to answer Q9 ~ go to the next section.

 

 

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9. Complete Table H for applications imvahing a a material change of use; reconh ‘guration ofa a lot; work on land below high-water mark and not
within a canal as defined under the Coastal Protection and Management Act 1995; or work on rail corridor land defined under the
Transport infrastructure Act 1994 - provide details for each owner on a separate row, aran an n atachment to this fom if applicable,

 

    

 
  

   

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* Owner's signature cannot be provided on the form if yau intend to submit the application electronically, Owner's consent must be provided to the assessment manager on an
attachment containing appropriate written documentation of the owner's consent. If the owner is a company, $127 of the Corporations Act 2001 (Cwealth) details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .

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