0014C22C.001

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            INTEGRATED PLANNING ACT 1997                                                                                                   Part A, Version 2.4, 29 May 2006
             Land owner's consent (if applicable)        20.  Land owner's consent to the making of this application:
            sptcatoe mst ota abe sported,                     p                 Name          TSigmature |                                                   ate
             application must contain, or be supported by, the
             written consent of the land owner/s, if the apptication .
           involves:                                             (i)
            () amaterial change of use;                        coe ee ee ee ne ene ce eee ccc cc ewww ecb enc cece cece nen n ence eee cece cece cece heel eeeeenee-
            (i) reconfiguration af a lot;                        es
            Gil) work on land below high-water mark & not within a (ii)
               canal as defined under the Coastal Protection and we eee ee ee ee    eee          ee eee eee eee           ee   ee        eee ee ee bee eee eee
                Management Act 1995;0r                            es
             (iv) work on rail corridor land defined under the  (iii)
               Transport Infrastructure Act 1994.              a a
             Section 3.8.1(2)(a) of the IPA provides that         .
             landowners consent is not required for a mobile or (iv)
             temporary ERA .                                   mom r rr tre eset cess cece ewww ene e een nb nnn nn nn nn nn nn nnn nnn nnn nn nena panne ns eseres
             For more information refer to Guide 1.             (v)
             Resource entitlement (if applicable)        21.  Does this application involve a State resource prescribed under a regulation (other than involving
             Section 3.2. 2 of mer requires at  oa            quarry material on State coastal land under the Coastal Protection and Management Act 1995)?
                 rce entitlement be given for applications
           involve a prescribed State resource.                    NO - goto Q24                         [1 YES - go to q22
             Section 3.2.1(10}(a)(Ii} of the IPA prescribes that .       to,                   .         .
             Satin cutee then i be propel mate         | 22.  This application is accompanied by evidence: (tick applicable box)
             wou eae      a the resoure¢ entitlement.         {J (i)   of the allocation of, or entitlement to, the resource - attach evidence and go to Q23(vi)
            Refer to schedule 10 of the Integrated Planning    [_] (ii) the chief executive of the department administering the resource is satisfied the
             Regulation 1998 that prescribes the nature of evidence    development is consistent with an allocation of, or entitlement to, the resource ~ go
             required by the State in support of the lodging of this                                                a
  @          development application.                               -  to Q23 .          .                             ..    .                  :     ,
                                                               C1 (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
            Advice for completing Q23       _____ | 23.        Evidence of the resource entitlement:
             ene onde On ti Oi obe          iFevidence is      (i)   Resource entitlement / authority    details              (vii) Official stamp of the department
             The official stamp of the Department of Natural                                                                      administering the resource (if
             Resources, Mines and Water is mandatory where the  .                                                                 applicable
             application involves any water or riverine quarry {ii} Name of delegated officer
             material under the Water Act 2000.
             Section 3.2.1(5A) allows the resource manager to limit
             the time the evidence may be used. Q23 (vi) must be iii     iti
             completed if the evidence Is time limited.        (ii)  Position of delegated officer
                                                              (iv)      ~~ of ~ officer
                                                                (v)  Date                                                     |
@                                                              (vi)    en date of evidence          a
             Assessment triggers                          24.  Is the IDAS Assessment Checklist completed and attached to this application?
             haconpbtonct Pos an Borteromeage          $       XX] YES                      [_] NO - the assessment manager may refuse to accept this application on the
              must be completed for all other applications,                                             grounds that the application has not been properly made
              Plans / drawings / reports                  25.  Plans/drawings/reports accompanying this application:
              spre popord & nal te aieen                             Plan Drawing /Report Number              |                Title =| Date
              An application should be accompanied by details to                   .                                               .
              manager, referral agencies and any person viewing                                                                                        October
              the application during public scrutiny or public     '                 4.
              notification to understand the scope of the proposal (i)  RO0610-01-A                               Proposal Report                        2006
             and any potential impact.                                  a ne fe                                             ee ee ne bee eee nee
                                                                  (ii)
                                                                  (iii)
                                                                  (iv)
              PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide ali applicable information required by Part A
                                 and any other relevant part of Form 1.
                                  rg
             OFFICE USE ONLY (appiicabie to assessment manager's)
                                                   DATE                            RECEIVING OFFICER’S | 4        C om           | REFERENCE