09/1024 - MCU - Detached House [As Published] · 132009.1024

 

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Part A, Version 3.1, 3 March 2008

 

Part A

Common details

      
    

NOTE: Answer all questions unless directed to go to a particular question. Refer to the end of the form for advice on how to complete this form.

nengenen 8

application i will ‘be issued

Company or organisation name (if applicable) Ch AS CLOUT Dee { & AQ

Individuat applican/Contact person (if tfiere is more than one applicant, provide additional applicant details on an attachment to this form)

Title Mr. First name |CHIAIS Last CLO

, name

   

* approval that may ba'issued as a Coriseit ice Off

 

 

 

 

 

 

 

 

 

 

 

relates QWeReA St SUNSHINE BEACH
Contact telephone nut fiber 54 THE \ ot ‘Mobile: shore umber O4 I24 CB 410

Facsimile umber’ . SHES ‘email address =| Chs risers ox he cle neo .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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14. Identify the premises by completing Table A, or Table B andior Table c fensure adequate in information is given to identify the premises)
Table A if the application is for a mobile and temporary Environmentally Relevant Activity (ERA), complete Table A only. Then go to 02.
ry od" Name Of, each. local government, area in which the mobilé:and temporary, ERA is praposed to operate

 

 

 

 

1.

 

 

 

OR

TableB Street address for the premises ( applicable box/es below and insert property description in the table. Identify each lot in a separate row.)
() (2 Street address / lot on plan for the premises (Appropriate for most apptications including building applications); OF

{ii) (Street address /lot on plan for the land adjoining or adjacent to the premises (Appropriate for development in water e.g. jetty, pontoon
etc) (Note: Lot on plan details may be obtained from titfe documents, a ‘Rate’ notice, or from the local government.)

 

 

Street address Lot on plan:description » Local government area (e.g.
Unit Street ‘ Post Plan type and ~ Logan, Cairns)
No: No. Street Name and official suburb/iocafity name Code Lot No. Plan-Number :

 

Ross Crescunt Noosa Heaas
4 Sunshine Beach ‘5b KPHED chine Coast

 

 

 

 

 

 

 

 

 

AND/OR
Table C Coordinates and/or a map of the premises (Appropriate for development in remote areas, over part of a lot, in water (e.g. channel dredging in Moreton Bay) etc.)
Coordinates
. nates i Zone Local. government area
_ (Note: place each sel of coordinates in a separate row) - Reference Datum (it applicabte)
Easting Northing Latitude Longitude

 

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(C Other

 

 

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