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

                              number               ($)                          form sighted by      sighted the form
                                                                                assessment
                                                                                 mana   er




The Sustainable Planning Act 2009 is administered by the Department of State Development, Infrastructure and
Planning. This form and all other required application materials should be sent to your assessment manager and any             ~
referral agencies.




8                                                                                            IDAS form 1-Application details
                                                                                              Version 2.017 December 2012

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