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

 o By making this application, I, the applicant, declare that the owner has given written consent to the making of the
 application.



 8. Does the application involve a State resource? (E.g.the application involves taking water or quarry material, or
 interfering with the flow of water. Refer to the notes at the end 9f this form for more information) (Non-mandatory
 requirement.)                                                     !!’




 o No                      o Not identified whether or 0 Yes-complete Table J
                                not the application
                                involves a State
                                resource




 Table J

Nature of State-owned resource (if identified)




19. Identify If any of the following apply to the premises (Tick applicable box/es.)
 o       Adjacent to a water body, watercourse or aquifer (e.g.creek, river, lake, canal)-complete Table K

 o       On strategic port land under the Transport Infrastructure Act 1994-complete Table L


 o       In a tidal water area-complete Table M


 o       On Brisbane core port land under the Transport Infrastructure Act 1994 (notable requires completion)


 o       On airport land under the Airport Assets (Restructuring and Disposal) Act 2008 (notable requires completion)



Table K

Name of water body, watercourse or aquifer


         Iv’/11

Table L

 Lot on plan description for strategic port land                    Port authority for the lot


     IV/It
Table M

 Name of local government for the tidal area (if applicable)        Port authority for the tidal area (if applicable)


    IVIII                                          I
                                                   /



 10.Are there any existing easements on the premises? (e.g.for vehicular access, electricity, overland flow, water
 etc.)

 [if’    No     0 Yes-ensure the type, location and dimension of each easement is included in the plans submitted

 11. Does the proposal include new building work or operational work on the premises? (Including any services.)


 !
 No 0 Yes-ensure the nature, location and dimension of proposed works                     are included in   plans submitted


5                                                                                                IDAS form 1-Application details
                                                                                                  Version 2.017 December 2012