App B - Effluent Information

       GENERAL NOTES: This form is to be used for the purposes of section 81 of the Plumbing and
       Drainage Regulation 2019 (PDR).

       1. Description of                 Street address (include number, street, suburb/locality and
          land                           postcode)
                                         122 Musa Vale Rd COOROY QLD 4563
                                         Lot and plan:
                                         Lot 304 SP 118015
                                                                                                            Local
                                         Shop/tenancy                                                       government
                                         number                               Storey/level                  area
                                                                                                            Noosa
                                         (if applicable)                      (if applicable)
       2. Permit details                Permit number                                     Date issued
                                         PL23/0174                                        13 July 2023

       3. Declaration/s
                                       1.        This certificate applies to all of the work authorised to be carried
                                         out under the permit
       Local government or
       the public entity may in         or
       certain circumstances
       accept verification from        2.        This certificate applies to part of the work authorised under a
       the responsible person            permit.
       that certain work not
       inspected     by     local
       government complies              If two (2) applies, provide a description of work covered by the certificate.
       with    the      relevant
       standards.
       4. Certification                This form certifies that the relevant local government or the public entity
                                       has decided to issue a Final inspection certificate for the work described
                                       above.

                                         The work is compliant, operational and fit for use.

                                        Date the inspection was carried
                                                                                             12 January 2024
                                        out

                                        Certificate number (if applicable)                   Not Applicable

                                        Issued by
                                                                                             Noosa Council
                                        (insert local government name/public entity)


                                        Date issued                                          25 June 2024




Document Set ID: 23075699
Version: 1, Version Date: 25/06/2024