09/0986 - Preliminary Building Approval [As Published] · 172009.986

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008
y completing Tables D, E, or F. (Nota: in most instances, the premises will not involve any of the

2. _ Identify if any of the following apply to the premises b'
‘one or more of these characteristics — complete only if applicable) ©

following characteristics, however some applications may involve
Table D Complete if the premises are adjacent to or associated with a water body, watercourse or aquifer (e.g. aver, creek, lake, canal)

Name of water body, watercourse or aquifer (if known)

 

 

 

Table E Complete if the premises are on Strategic Port Land under the Transport Infrastructure Act 1994
Lot on plan description for strategic port land Port authority for the lot

 

 

 

Table F Complete if the premises are in tidal water

 

Namie of local govemment for the tidal area (/f applicable) Name of port authority for the tidal area (if applicable)

 

 

 

1.

3. Indicate the total area of the premises on which the development is proposed: (Note: The total area may include land both above end below water}
Total area of premises (land on which the development Is proposed)
. 4! [Ce hectares (appicabie unt)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Existing use of the premises

4. Current use/s of the premises: (e.g. vacant land, house, townhouses, apartment building, shop, service station, school, sugar cane farming etc.)

 

 

 

 

 

Veousnn
“5, Are there’any existing easements on the premises? (e.g. lor vehicular access, electricity, overiand flow, water atc.)
No | Yes — Ensure the type, location and dimensions ofeach easement are included in plans, submitted with the application
‘Proposal details . . co, : :
omnis . - 4 + * w

6. Brief description of the proposal: (e.g. 6 unit apartment butiding, 30 fot residential subdivision, a bore, aquaculture etc.)

7. Does the proposal include new building work or operational work (including any services) ON the premises?
oO No oa Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, s

 

 

 

 

submitted with the application

“Resource entitlernent (if applicable} = further information is provided inthe advice section at the. end ofthe form : » wep wg ae
olve taking or interfering with a State resource and therefore require a resource entitlement? (e.g. the application

8. Does the application inv
involves State fand (leased and freehold), declared Fish Habitat areas, taking quarry material, taking or interfering with water under the Water Act 2000, etc.)

Wi No - Goto Q9 oO Yes - Complete Table G - provide details for each evidence required on a separate row. if applicable. Evidence of resource allocation or
entitlement must be submitted with the application. You do not need to answer Q9 - go.to the next section.

 

Nature of State-owned resource

TableG [Nature of evidence required
State Government Date of | Date of

Allocation/entitlement sai i ei
reference number Name ot authorising officer Position of authorising officer Department issue _| expi

 

 

 

 

 

 

 

 

 

 

 

 

Owner's consent (it applicable) = farther information is provided in the advice section al ine'end of the form . . Cor . :
9, Complete Table H for applications involving a material change of use; reconfiguration of a lot; work on land below high-water mark and not
within a canal as defined under the Coastal Protection and Management Act 1995; or work on rail corridor land defined under the

Transport Infrastructure Act 1994 - provide details for each owner on a separate row. or on an attachment to this form if applicable.

 

Date consent
was obtained

5

Table H Premises Owner's namels Details of the premises owned : ‘
‘ and postal address. (street address or lol an plan description) Owner's signature

y {1 |Zeo7 OY SE KE LEV CO

 

 

 

 

 

 

Ay per

* Owner's signature cannot be provided

 

 

 

on the form If you intend to submit the application electronically. Owner's consent must be provided fo the assessment manager on an
attachment containing appropriate written documentation of the owner's consent. If the owner is a company, $127 of the Corporations Act 2001 (Cwealth} details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .

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