Development Part 1 of 3 · OPW11/0335

18. Is owner's consent required for this application? (refer to notes at the end of this form for more information)



r>K No
q    Yes - complete either table D, table E or table F as applicable



9. Does the application involve a state resource? (e.g. the application involves state land, or taking quarry
materials Refer to the notes at the end of this form for more information)


     No                            q Yes - complete table G


10. Identify if any of the following apply to the premises (tick applicable box/es)


          adjacent to a water body, watercourse or aquifer (e.g creek, river, lake, canal) - complete table H

q         on strategic port land under the Transport Infrastructure Act 1994 - complete table I

          in a tidal water area - complete table J

11. Are there any existing easements on the premises? (e.g. for vehicular access, electricity, overland flow,
     water, etc.)


q No        LX Yes - ensure the type, location and dimension of each easement is included in the plans submitted

12. Does the proposal include new building work or operational work on the premises? (including any
     services)                                                                                                            I
[X] No      q Yes - ensure the nature, location and dimensions of proposed works are included in plans submitted

13. Is the payment of a portable long service leave levy applicable to this application? (refer to the notes at the
   end of this form for more information)


 q No - Go to question 15                    Ix Yes

 14. Has the portable long service leave levy been paid? (refer to notes at the end of this form for more
 information)


 FX_ No
                 complete table K and submit with this application the yellow local government/ private certifier's copy of
 q Yes -
                 the receipted QLeave Form



 15. Has the local government agreed to apply a superseded planning scheme to this application under
    section 96 of the Sustainable Planning Act 2009?



 X     No

 q     Yes - provide details below