09/1270 - MCU - Detached House [As Published] · 132009.1270

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1.3 March 2008

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of water body, watercourse or aquifer (if known) . |
[ |
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 lot
|
Table F Complete if the premises are in tidal water
f Name of local government for the tidal area (# applicable} | Name of port authority for the tidal area (if applicasbie}
[1
3. Indicate the total area of the premises on which the development is proposed: (Note: The tolal area may include land both above and be-fes:
[ Total area of premises
[soo (x]m? (J) hectares Fike

 

 

Existing use of the premises,
4. — Current use/s of the premises: (e.g. vacant land, house, townhouse: partment building. shop, service ition. school, sugar cane farming etc.)

 

11 [vacant tand
5. Are there any existing easements on the premises? je.y. for vehicular access. electicity, overtand flow, water etc)?
BR] No (L] Yes - Frese sr ype aroren cae

Proposal details - .
6. Brief description of the proposal fz.9. 6 unit aganment building. 30 fot residential subdivision. a bore, aquaculture)

   

ORS OF PCR onchediery Be Tix ie the 302

 

| Proposed new single residence
|

 

7, Does the poposal include new buildings or operational work (including any services) on the premises?
CINo [RX] Yes - étsue tie nature. ! suebuited witht the agp’
Resource entivement (fepptcabh) - father informeiis: is proved tf 0 advice section at the endot de tery

8. Does the application involve taking or interfering with a State resource and therefore require a resource entitlement? (e.9. the application
involves State land (leased and freehold). declared Fi:tt Habitat areas, taking quarry mgtial, taking or interfering with water under the Watet Act 2000, cic. }

No - OD Yes -<-

ah,

   

t

    
 

Owner's consent @appfrabie) -funhor inarmapon s provided in the setvice section at ihe end atthe 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 land defined under the
Transport Infrastructure Act 1994 - pr: AES OD SUBNET: GAY OF MoE On

    

he Ceca fez

 

 

    

 

 

  

 

 

 

! - : cs
i Premises Owner's haniels | Details of the premises owned | ‘Ownars signature. . | «ate consent
| fable 8 and postat address {siteet address or fot on plan description) i Owners Sapa * was obtained
K & J Fairs de eies Ve ON, pr
1 84 Lorrikeet Drive, Perigian | Lot 32 SP 111721 : rT . She.
Beach ’
y

 

 

 

 

 

* Owner's signature cannat be provided on the form if you intend to submit the application electronically. Owner's cansent dust oe provided to the assessment man ager on an
attachment containing appropriate wrilten documentation of the owner's consent, If tie owner is a company, $127 of the Corporations Act 2001 (Cwealth) details how a
company may sign as owner. Templates for lhe provision of owner's consent are available on the IPA website

0g SEP 2003