10/0342 - Op Works, Prescribed Tidal Works - Jetty [As Published] · 142010.342

+ 16 Feb 10 07:57a User1

 

0732523966 p.4

 

[8.8 owner's consent required for this appficatian? (refer to notes at the end of this form for more information) |

 

© No
Yes - complete either table

D, table E or table F as applicable

 

(Table D (note: do not complete this table if lodging the application on-fine using Smart eDA)

 

Name of owner/s of the tand

Signature of owner/s of the fand!

Date

We, the above-mentioned ownerts of the ‘ars-eensent to the making of this application.

 

WILRIFT PAL

 

 

 

LE.
>) aa 2) Zo asco)

1S-2-4/0

 

 

 

[Table E

 

e Name of owmer!s of the land

 

 

 

(2) The owner's written consent is attached or will be provided separately to the assessment manager

 

[Table F

 

o By making this application,
the application,

 

Name of owners of fhe land |

{, the applicant, dectare that the owner has given written consent to the making of

 

 

. Does the appiication involve a state resource? (e.g. the application involves state land, or taking quarry
matertals. Refer to the notes at the end of this form for more information) :

 

 

EQNo [xX] Yes - complete table G

 

Aporeation Detess- IDAS form f
Version 1.0 18 December 2009