07/0967 - MCU - Detached House [As Published] · 132007.967

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INTEGRATED PLANNING ACT 1997

PartA, Version 2.2, 25 July 2005

 

Land owner’s consent (if appicable)

Section 3.2.4(10)(a} of the IPA prescribes that an
application cannot be taken to be property made
without the land owner's consent.

An application must be supported by tre consent of
aff land owner if the application involves:

() a material change of use;

(i) reconfiguration of a lot;

(iif) work on land below high-water mark & not within
acanal as defined under the Coastal Protection
and Management Act 1995;0r

work on rail corridor land defined under the
Transport Infrastructure Act 1994,

For a mobife or temporary ERA - landowner's
consent is not required.

For more information refer to Guide 1.

(v)

Land owner's consent to the making of this application:
Name p Sign

 

 

 
 

 

 

 

 

 

 

 

Resource entittement {if applicable}

Section 3.2.1(10)(b} of the IPA prescribes that an
application cannot be taken to be property made
without evidence of the resource entitlement.

Advice for completing Q22

Refer to schedute 10 of the Integrated Planning
Reguiation 1998 that prescribes the nature of evidence
required by the State in support of the lodging of this.
development application.

Advice for completing Q23

The information in (i) - (v) is mandatory if evidence is
required under Q22 (ii) or (iii) above.

The official stamp of the Department of Natural
Resources and Mines is mandatory where the
application involves taking of interfering with water or
riverine quarry material under the Wafer Act 2000.

21.

22.

23.

 

Does this application involve taking or interfering with (other than interfering with quarry material on State
coastal land under the Coastal Protection and Management Act 1995) a State resource?

EX] NO - go to 024 (11 YES - go to 022

This application is required by regulation to be accompanied by evidence: (tick applicable box)
C1 (i) of the allocation of, or entitlement to, the resource — attach evidence

[J (ii) the chief executive of the department administering the resource is satisfied the development is
consistent with an allocation of, or entitlement to, the resource - go to Q23

Li (ili) the chief executive of the department administering the resource is satisfied the development

application may proceed in the absence of an allocation of, or entitlement to, the resource —
go to Q23

Evidence of the resource entitlement:

(i) Resource entitlement / _ details
(ii) Name of “a officer

(iii) Position of delegated officer

(iv) Official stamp of the department
administering the resource (if
applicable)

 

  

 

 

 

 

 

Assessment triggers

This checklist does not apply if the application requires
the completion of Parts A and B of the Form only. It
must be completed for all other applications.

24.

Is the [DAS Assessment Checklist completed and attached to this application?

{] Yes KK] NO - the assessment manager may refuse to accept this application on the

grounds that the application has not been properly made

 

Plans / drawings / reports

An application should be accompanied by details to
support the proposal & enable the assessment
manager, referral agencies and any person viewing
the application during public scrutiny or pubtic
fotification to understand the scope of the proposal
and any potential impact.

 

28,

Plans/drawings/reports accompanying this application:
Plan | Drawing / Report Number

 

Date
04/05/07

 

Trust Clout

(i) Paul CLout Design

 

 

 

 

 

 

 

 

PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide ail applicable information required by Part A
and any other relevant part of Form 1.

 

OFFICE USE ONLY (applicable to assessment manager's)

 

DATE

[0 94F.00
“oa wiley Ir applicrtion—
To,

RECEWVED

IE f- 7007) RECENING OFFICER'S | Warde Hern

REFERENCE
NUMBERS

 

morrfas7 |

Notification of Engagement of Private Certifier (Optional formal)

Council. ! have been engaged as the private certifier for the building work referred to in this application.

 

Date ofengagement { /

Accreditation Number.

___ Name: Signature: