10/0916 - Preliminary Building Approvals [As Published] · 172010.916

OI
uveNnnresel

      

{] Ne
&) Yes - coinplete either table D, table E or table Fas applicable

 

Table D (rote; do not complete this fable if lodging the application ondine using Smart eDA)

 

Name of owner/s of the land Jan James Gifford Martin

 

We, the above-mentioned owner/s of theta land, corset to the making of this application.

=,
Signature of owners of the land Mnitc.

Date 31t [Qom

Table E

 

 

 

 

 

 

 

 

Name of owner/s of the land

 

 

(CI The owner's written cansent is attached or will be provided soparately to the assessmont manager

 

‘rable F

 

 

Name of owner/s of the land

 

oO By making this application, |, the applicant, declare that the owner has given written consent to the making of
the application.

 

  
  

 

 
 
 

 

 

pepe tear eee ANG
Reus Topeka alt

[2] Ne (Yes - complete table G

 

 

 

 

 

ake ae Ta ae Tea a Cy PTET
VERTIS TS LoWenieauuy ae Bro ase Un au RIGHNS
() adjacent to a water body, watercoures or aquifer (e.g creek, Hiver, lake, carl) » complete table H
(I onstrategic port land under the Transport Infrastructure Act 1994 - complete table |
(0 __ ina tidal water area - complete table J

    

 

 

 

 

 

 

GaNo []Yes - ensure tha type, location and dimension of each easement is included in the plans submitted

 

 

 

a Roplication betelle- INAS Torm 7
. Version 1.6 18 Decembar 2009

RIT END NIT ECACAT ICL) TO *7OT aTAyTseasen