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

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008
2. _ Identify if any of the following apply to the premises by completing Tables D, E, or F. (Note: in most instances, the premises will not involve any of the
following characteristics, however some applications may involve one or more of these characteristics - complete only if applicable)

Table D Complete if the premises are adjacent to or associated with a water body, watercourse or aquifer (e.g. river, creek, fake, canal)

 

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

 

 

Tab!

 

 

le 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
1,

 

 

 

Table F Complete if the premises are in tidal water

 

Name of tocal government for the tidal. area (if appitcable) . 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 tofal area may include fand both above and below water)
q Total. area of premises (land:on which. the development is proposed) -

5 ae,

Existing: use'o ‘Of, ithe prernises,
4.

 

 

 

 

 

 

 

 

 

 

m (_] hectares (~ appicable unit)

 

 

  

h

   

vedtal dod e

4

  

    

inp mame ets cde ab AN Bs

Current use/s of the premises: {e.g. vacant land, house, fownhouses, apartment building, ‘hop, Service station, school, sugar cane farming etc.)
House

 

 

¥s,

 

 

Are there any existing easements’on the premises? (e.. for vehicular access, electricity, overland flow, water efc.)
o No oO Yes - Ensure the type, location and dimensions of each easement are included in plans, submitted with the application

wo apa oat

‘Propotal de detail
6.

     

oh. aaa.

 

Vinings pa!

 

wen ea, . Bo a
Brief description of the proposal: (e.g. 6 unit apartment building, 30 fot residential subdivision, a bore, aquaculture etc.)
New House

Does the proposal include new building work or operational work {including any services) on the premises?
LINo +

 

 

Ls

 

 

Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application

 

  
  

‘Resource en

  

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8. Daes the application involve taking or interfering with a State resource and therefore require a resource entitlement? (e.g. the appicaton
On 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 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
Allocation/entitlement si mi sai State Government Date of |: Date of
reference number Name of authorising officer Position of authorising officer Department issue _| expiry
1.

 

 

 

 

 

 

   

 

 

 

 

Owner's consent (if. appli cable} further information is provided in the ativice section at at the end of the form : .
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 {and defined under the
Transport Infrastructure Act 1994 - provide details for each owner on a separate row, or on an attachment to this form if appicable.

 

 

 

 

 

 

 

Table H Premises Owner's name/s Details of the premises owned si ianatige® vo Date consent
and postal address (street address or lot on plan description) 9 od was obtained
_ DARKEN MRE 1 ROSS cRet ean
fo WERT CT, Sunes 3/e/o2
CONCH UGE 7 QLD CUNSHING Beret

 

 

 

Owner's signature cannot be provided on the form if you intend to submit the application electronically. Owner's consent mist 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 IPA websi

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