Development Application Application - Vegetation Removal IDAS forms 1 & 6 · OPW12/0161

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                 DDD
     Table C-premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g. channel
     dredging in Moreton Bay)

     Coordinates                                                                                                                                                                                                Zone                                      Datum                                                Local government
     (note: place ~ach set of coordinates in a separate row)                                                                                                                                                    reference                                                                                      area      (if applicable)

         Easting                                               Northing                                 Latitude                                                        Longitude


                                                                                                                                                                                                                                                           D GDA94
                                                                                                                                                                                                                                                           D WGS84
                                                                                                                                                                                                                                                           D other

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          D                  No



          o Yes-complete either table D,table E                                                                                                    or table F as                    applicable

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          Table D

          Name of ownerls of the land                                                                                                          .$E.12..e.0’c... E aA .,---re. 10

          I/We, the above-mentioned ownerls of the land, consent to the making of this application.

          Signature of ownerls of the land
                                                                                                                                                       p 3 7T~                      (



          Date                                                                                                                                 25 ~utJE.                                                        ’20 1’2




                                                           3                                                                                                                                                                                                                 Application details-/DAS form 1
                                                                                                                                                                                                                                                                                 Version 1.0 18 December 2009