OPW13/0007 Application for permit to damage vegetation 3 Black Mountain Rd Black Mountain

Table C-Additional aspects of the application (If there are additional aspects to the application please list in a
separate table on an extra page and attach to this form.)

       o Refer attached schedule           [Q(Not required

2. Is the application for a mobile and tempprary environmentally relevant activity (ERA)?


           No-continue to question 3

o          Yes-complete Table 0and then go to question 6

Table D-name of each local government area in which the mobile and temporary ERA is proposed to operate




3. Location of the premises (Complete Table E and/or Table F as applicable. Identify each lot in a separate row.)


Table E-street address and lot on plan for the premises or street address and lot on plan for the land adjoining or
adjacent to the premises. (Note:this table is to be used for applications involving taking or interfering with water).
(Attach a separate schedule if there is insufficient space in this table.)
            Street address and lot on plan (All lots must be listed.)
       ~    Street address and lot on plan for the land adjoining or adjacent to the premises (Appropriate for
            development in water but adjoining or adjacent to land, e.g. jetty, pontoon. All lots must be listed)
Street address                                                             Lot on plan                  Local government area
                                                                           description                  (e.g. logan, Cairns)

Lot        Unit     Street        Street name and official      Post-      Lot no.      Plan type
           no.      no.           suburb/locality name          code                    and plan no.

                   8LAcK                BUrCK Hol/J/Tlrlll 4-S{,3
i)         5      HD 1IPT"/rWIe   "
                                                                            4-          ’KPVI"5’tT7 SUN5HIIVt3 CeAsi
ii)
iii)
Planning scheme details (If the premises involves multiple zones, clearly identify the relevant zone/s for each lot in a
separate row in the below table. Non-mandatory.)
Lot        Applicable zone / precinct                Applicable local plan / precinct           Applicable overlay/s

i)
ii)
iii)




3                                                                                                       IDAS form 1-Application details
                                                                                                          Version 2.0 17 December 2012