Development Application IDAS Forms 1 & 6 · OPW12/0360

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       Table C-premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g. channel
       dredging in Moreto Bay)

       Coordinates                                                                                                     Zone                    Datum                                  Local government
       (note: place each set of coordinates in a separate row)                                                         reference                                                      area   (if applicable)

       Easting                   Northing            Latitude                            Longitude


                                                                                                                                                D GDA94
                                                                                                                                                D WGS84
                                                                                    ..




                                                                                                                                                D other




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        ~ No
                                                                                or table ~ as
        D Yes-complete either table D, table E                                                   applicable,



        Table D

        Name of owner/s of the land


        I/We, the above-mentioned owner/s of the laml, consent to the making of this application.

        Signature of owner/s of the land



        Date




                               3                                                                                                                         Application details-IDAS form 1
                                                                                                                                                             Version 1.0 18 December 2009