09/0134 - Operational Works - Prescribed Tidal Works - Transport Type 5 (Jetty) [As Published] · 142009.134

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 nol involve any of the
following characteristics, however some applications may involve one or more of these characteristics - complete only if applicable)

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

 

Name of water body, watercourse or aquifer {if known)

 

 

 

1.

 

 

Table E Complete if the premises are on Strategic Port Land under the Transport infrastructure Act 1994

 

Lot on plan description for strategic port land

Port authority for the Jot

 

 

Table F Complete if the premises are in tidal water

 

Name of local government for the tidal area (/f applicable) Name of port authority for the tidal area (if applicable)

 

 

 

 

 

 

3. _ Indicate the total area of the premises on which the development is proposed: (Note: The tota! area may include land both above and below water)

 

Total area of premises (land on which the development is proposed)
: (Om  Dhectares (~“eppicabie unit

 

 

 

 

 

 

 

 

 

 

 

Existing use of the premises

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

 

 

 

 

5. Are there any existing easements on the premises? (e.g. for vehicular access, electricity, overland flow, water etc.)
& No oO Yes - Ensure the type, location and dimensions of each easement are included in plans. submited with ne application

Proposal details
6. Brief description of the proposal: (e.9. 6 unit apartment building, 30 Jol residential subdivision, a bore,

aquaculture etc.)

 

 

PONTOON, WALKWAY, STARTER DECK

 

 

7. Does the proposal include new building work or operational work (including any services) on

the premises?

oO No & Yes - Ensure the nature. location and dimensions of the Proposed works are inciuded in plans, submited with the application

Resource entitlement (if applicable) — further information is provided in the advice section at the end of the form

8. Does the application involve taking or interfering with a State resource and therefore require a resource entitlement? {e.. the application
involves State land (leased and freehold), dectared Fish Habitat areas, taking quarry material, taking or interfering with water under the Water Act 2000, etc.)

No - Go to a9 oO Yes - Complete Table G ~ provide details for each evidence required on a separate row, f applicable. Evidence of resource allocation or
entitlement must be submited with the appfication. You do noi need fo answer Q9 - go to the next section.

 

Nature of State-owned resource

 

TableG Nature of evidence required

 

Allocation/entittlement

reference number | Name of authorising officer Position of authorising officer

State Government
Department

Date of | Date of
issue_| expiry

 

 

 

 

 

 

 

 

 

 

Owner’s consent {if applicable} — further information is provided in the advice section at the end of the form

9. Complete Table H for applications involving a material change of use; reconfiguration of 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 tand defined under the
Transport infrastructure Act 1994 - provide detaiis for each owner on a separate row. ar on an altachment ic this form if applicable.

 

Table HK Premises Owner's name/s Details of the premises owned
and postal address {street address ar fot on plan description)

Owner's signature*

Date consent
was obtained

 

1. | Johu MeDermott| 3 Dolpluine Cres.

 

 

 

 

tot 697 RPNIOS72

See ottact_ed

Noosauviiile COoUuseut fori

 

 

 

* Owner's signature cannot be provided on the form if you 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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