07/1849 - Op Works - Residential Subdivision [As Published] · 142007.1849

INTEGRATED PLANNING ACT 1997
_ Land owner's consent (if applicable)

‘Section 3.2.1(3) of the IPA prescribes that an
. pplication must contain, oc be supported by, the
vatten consent told owners, if tha application

tan material change of use;

{il} reconfiguration of a lot:

/ work on Land below high-water mark & not within a
canal as defined under the Coastal Protection and
Management Act 1995;0r

“ha work on rall corridor land defined under the

* Transport infrastructure Act 1994.

Saction 3.8.1(2)(a) of the IPA provides that

landowner’s consent is not required for a mobile or

- temporary ERA .

+ For more information refer to Guide 1.

20. Land owner's consentto the making of this application:

Part A, Version 2.4, 29 May 2006

 

Name

Signature

 

 

 

 

 

 

 

“Resource entitlement (if applicable)

j Section 3.2.1(5) of the IPA requires evidence of

* resourme entitiement be given for applications that

involve a prescribed State resource.

* Section 3.2.1(10)(e)(i) of the IPA prescribes that an
application cennot be taken to be properly made

.. Without evidence of the resource entitlement.

. Advice for completing Q21 & 22

Refer to schedule 10 of the integrated Planning

Regulation 1998 that prescribes the nature of evidence

tequired by the State in support of tha lodging of this

development application,

Advice for completing Q273
The information in (i) ~ (v) is mandatory if evidence is
required under 022 {ii) or (iii) above.
* The official stamp of the Department of Naturat
Resources, Mines and Water is mandatory where the
; application involves any water or riverine quarry
material under the Water Act 2000.
_ Section 3.2.1(5A) allows the resource manager to limit
+ the time the evidence may be used, 023 (vi) must be
completed if the evidence is time Kimited,

Assessment triggers

21.

23,

Does this application involve a State resource prescribed under a regulation (other than involving
quarry material on State coastal Jand under the Coastal Protection and Management Act 1995)?

[X] NO - goto a24

(DYES - go to 022

This application is accompanied by evidence: (tick applicable box)
(1 ()) ofthe allocation of, or entitlement to, the resource - attach evidence and goto a23(09

1 {ii) the chief executive of the department administering the resource is satisfied the
development is consistent withan allocation of, or entitlement to, the resource - go

to Q23

(1 (iii) the chief executive of the department administering the resource is satisfied the @

development application may proceed in the absence of an allocation of, or
entitlement to, the resource - go to Q23

Evidence of the resource entitlement:

(i) Resource entitlement / ane details
(i) Name of cle officer
(iii) Position of seas officer” _- .

{iv) Signature of delegated officer

(vii) Official stamp of the department
administering the resource (é
applicable)

 

 

 

 

 

(¥) Date

(vi) fran-see olen eat :

 

 

 

24, Is the IDAS Assessment Checklist completed and attached to this application?

 

 

 

 

  

This checklist does not epply if he pplcaton requires ] Yes C].No- ~ the assessment manager may refu ls

' the completion of Parts A and B of the Form only. tt iy refuse to accept this application on the
“munya oma Sora fer epeatons: grounds thet the application has nat been properly made ;
‘Plans f drawings / reports 25. Plans/drawings/reports accompanying this application:

“apenas pte needy aa Plan / Drawing / Report Number Title

i manager, referral and viewing ;

on anpisabon auing pablo tarde or pub () O7093( — Of Acca PLAn)

notification to understand the scope ofthe proposal fo [oom mtn ont t rc Src o nrc nese e eee r nnn a donno ns aenwnenrercerewaccewaccane

* and any potential impact. (ii)

/ (iii)

(w)

i

 

 

 

 

 

 

PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide all applicable information required by Part A
and any other relevant part of Form 4.

 

OFFICE USE ONLY (eppticable to assessment manager's)

 

 

 

 

 

FEE(S) DATE RECEIVING OFFICER'S | SereRENCE
RECENED 2 WAMEIS WUMBERIS
Notification of Engagement of Private Certifier (Optional fonnat) ,
To, Council. | have been engaged as the private certifier for the building work referred to in this application.
Date ofengagement / { Accreditation Number. ___. Name. Signature: