09/0392 - Preliminary Building Works Assessable Against the Planning Scheme [As Published] · 172009.392

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008
Table D Complete it the premises are ? adjacent to or associated with a water body, watercourse or aquifer (e.g. river, creek, lake, canal)
Me ouirse’é f aquifer (itn) eee : i
li

Name, ‘of Water body, watercours
Table E Compete i the > premises are on Strategic Port Land under the Transport Infrastructure Act 1994

i] NA

 

      

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

3. Indicate the total area of the premises on which the development is proposed: (Note: The total area may include land both above and below water)

 

 

 

m? (hectares (Tick applicable unit)

 

 

 

 

 
 
  
 

 

Tr ee ue eat,

 

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

 

| 1 Dwelling

 

5. Are there any existing easements on the premises? (e.g. for vehicular access, electricity, overland flow, water etc.)?
&] No O Yes - Ensure the type. location and dimensions of each easement are included in plans, submitted with the application

[Proposal detail
6. Brief description of the proposal (e.g. 6 unit apartment se 30 lot residential subdivision, a bore, aquaculture)

 

 

Exoeure:

  

 

Dwelling Altterations/Additions

 

 

 

7. Doas the poposal include new buildings or operational work (including any services) on the premises?

(J No BX Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application

    

 

[Resource:entitlement: (if 3oplicable)  - further information'is provided in the advice. section at:the. end of the formes.

8. Does the application involve taking or interfering with a State resource and therefore require a resource entitlement? (e.g. the application
involves State land (leased and freehold), declared Fish Habitat areas, taking quarry material, taking or interfering with water under the Water Act 2000, etc.)

] No - Goto a9 oO Yes -Complete Table G - provide details for each evidence required on a separate row, if applicable, Evidence of resource
aifocation or entitlement must! be submitted with the application. You do not need to answer Q9 - go to the next section.

ee

 

kage
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.

lowner’ 's:consent (if applicable) 5 - “further information.i& ‘provided in inthe advice’ section atthe: rand, of thie forms

 

 

Table H

 

 

 

1 NIA

 

 

 

 

 

 

* Owner's signature cannot be provided on the form if you intend to submit the application electronically. Owner's consent must be provided to 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 PA website .

 

 

 

   
 

Table i