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

    Table F-premises coordinates (Appropriate for development in remote areas, over part of a lot or in water not
    adjoining or adjacent to land e.g. channel dredging in Moreton Bay.) (Attach a separate schedule if there is insufficient
    space in this table.)

    Coordinates                                                        Zone         Datum              Local government
    (Note:place each set of coordinates in a separate row.)            reference                       area   (If applicable)

    Easting          Northing         Latitude          Longitude

                                                                                     D     GDA94

                                                                                     D     WGS84

                                                                                     D     other


    4. Total area of the premises on which the development Is proposed (indicate square metres).


           J. 04 H-C-/).(lES
               >



         c                              c   c




    5. Current use/s of the premises (e.g.vacant land, house, apartment building, cane farm etc.)



        HousE

    6. Are there any current approvals (e.g.a preliminary approval) associated with this application? (Non-
    mandatory requirement.)

             No      D      Yes-provide details below

    List of approval reference/s                        Date approved (dd/mm/yy)           Date approval lapses (dd/mm/yy)




    7. Is owner’s consent required for this application? (Referto notes at the end of this form for more information.)


    [0 No
    D        Yes--complete either Table G, Table H or Table I as applicable

    TableG

    Name of ownerls of the land

    I/We, the above-mentioned ownerls of the land, consent to the making of this application.

    Signature of ownerls of the land


    Date


    Table H

    Name of ownerls of the land


    D Th       owner’s written consent is attached or will be provided separately to the assessment manager




I   Table I

    Name of ownerls of the land


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