Application for permit to damage vegetation - OPW13/0669

Table K
                                                                      Port authority for the tidal area (if applicable)
Name of local   gove~n~t fOCthe tidal area (if applicable)
                            ’-    ,
                     ,’-’



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

       )Hater etc)
                                                                                                      in the plans submitted
                                                          dimension of each easement is included
~       No
              ~Yes-ensure the type, location and
                                                      work or operational work on the premises? (Including
                                                                                                                     any
9.      Does the proposal include new building
        services)
                                                                                                 included in plans submitted
                                                        and dimension of proposed works are
q}J     No    0 Yes-ensure the nature, location
                                               service leave levy applicable to this application?
                                                                                                       (Refer to notes at the
10.      Is the payment of a portable long
         end of this form for more information.)

                             12       DYes
 ~No--gO question
                to

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

 o      No
                                                                                                            certifier’s copy of the
                                               with this application the yellow local government/private
 o      Yes-complete Table L and submit
        receipted QLeave form

 Table L
                                                                                                                           number
                                                                     Date paid        QLeave project number (6digit
 Amount paid                                                                          starting with A, E, L or P)
                                                                                                        ,

                                                                     (dd/mm/yy)


                                                                                                                      under
  12.     Has the local government agreed     apply
                                                to        a   superseded planning scheme to this application
                        the Sustainable Planning Act 20091
          section 96 of


  o      No

                                       below
     o Yes-please provide details
                                                                                     Reference number of written notice given
                                                     Date of written notice given
     Name of local government
                                                     by local government             by local government (if applicable)
  ~~.YJ> \k ~AA      0   ~~" ~W (dd/mm/yy)




                                                                                                      IDAS form 1     Ipplic.ltl(’TI dt ’’:11;:;
                                                                                                                       :~Oc    1
                                                                                                                                   July ’C1..!