09/1058 - MCU - Detached House [As Published] · 132009.1058

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INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008

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Common details

INOTE: 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.

 

Applicant details (The Applicant is the person responsible for making the application and need nof be the owner of the fand. The Applicant is responsible for ensuring the
information provided on the IDAS Application Form i$ correct.’ This information is retied upon by the Assessment Manager and any referral agencies when assessing and .....
deciding this application.” By lodging this application, the Applicant incurs the obligations and responsi jities prescribed byt the IPA, Any development pert or prefiminen
approval that may be issued as a consequence of this application will be issued to the Applicant) . RE

 

   

 

 

 

 

 

Company/organisation name (if applicable) [The Certifier Pty Ltd

 

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

Title Miss Firstname — [Janice ; ____ jj Last name Bradfield :

Postal address lPo Box 368 CLEVELAND QLD 4163

Contact telephone number |07 3821 8777 Mobile phone number :

Facsimile number for 3821 8725 4 e-mail address [email protected]

 

 

 

 

 

 

 

 

 

 

 

 

 

‘Details of the premises (.¢, the land on which the development is proposed .- refer fo the advice at the end of the form) i ee l
1. Identify the premises by completing Table A, or Table B and/or Table C (ensure adequate information is given to ident the premises)
Table A If the application is for a mobile and temporary Environmentally Relevant Activity (ERA), complete Table A only. Then go to Q2.

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OR
Table B Street address for the premises (tick applicable box/es below and insert property description in the table. Identify each lot in a separate row.)

 

 

    

‘ge Name-of each local government area in which the mobile and temporary ERA is proposed'to operate” *kys#"

 

 

 

 

(i) (J) Street address / lot on plan for the premises (Appropriate for most applications including building applications); or

(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: Loton plan details may be obtained from title documents, a ‘Rate’ notice, or from the local government.)

 

 
 
  

 

 

  

 

 

 

 

 

 

 

 

 

 

oss siti, Sell Lot on:plan description | aie wuvsare. aise zante” oy
_ Unit Plan type'and
"No" 1" “ Oe aneeae Plan Number .|
[1 8 __| Piper Street, Peregian Beach 4573, «(405 p93tt6 Sunshine Coast - Noosa
AND/OR
Table C Coordinates and/or a map of the premises (Appropriate for development in remote areas, over part of a fol, in water (e.g. channel dredging in Moreton
Bay) etc.)

 

 
   
 

   

  

 

4emp Coordinates > 4
{Note: place each set of coordinates.in a separate.row)

 

   

Zone

ie Easting sto [: ;Northings«} 44 Latitude | Longitude Reference

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[" Other-

 

Local government ar
i if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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)