DA Form 1 & Plan

 
   
 
  
 

CL Street address AND lot on plan (ai/ots must be listed), OF

(J Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
water but adjoining or adjacent to land e.g. jetty, pontoon; ail lots must be listed).

Unit No. | Street No.

     

     
  
    
 

Suburb
co

Local Government Area(s)

   
  
    
  

Street Name and Type
ST
Plan Type and Number (e.g. RP, SP)

  

     
   

  
  
 

  
  

Postcod | Lot No.

e

     
      

       

z
Street No.

cH 6
Street Name and Type

SA SHRE
Suburb

   
   
     
  

    
  

      

    

Unit No.

       

Postcod | Lot No.

e

        

     
  
      

Plan Type and Number (e.g. RP, SP) Local Government Area(s)

 

  
 

(1 Coordinates of premises by longitude and latitude
Latitude(s) Datum

LJ wese4
LC ebag4

(Other:

Longitude(s) Local Government Area(s) (if applicable) |

    

      
   
 
   

    
   
 

     
 

C1 Coordinates of premises by easting and northing
Easting(s) Northing(s) _ Zone Ref.

    

    
   
   
 

Datum Local Government Area(s) (if applicable)

       
  
  
 
 

[Osa | Cwesea
| Oss Cl epao4
| (56 (J Other:

   
 

_] Additional premises are relevant to this development application and their details have been attached in a
schedule to this application |
CINot required

 
    

(1 In or adjacent to a water body or watercourse or in or above an aquifer

Name of water body, watercourse or aquifer: Pome Tee |

(J On strategic port land under the Transport Infrastructure Act 1994
Lot on plan description of strategic port land:

 

 

 

Name of port authority for the lot:
| [J Ina tidal area
Name of local government for the tidal area (if applicable):

 

 

Name of port authority for tidal area (if applicable):
LD On airport land under the Airport Assets (Restructuring and Disposal) Act 2008

Name of airport:

 

 

(LJ Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994
EMR site identification: :
{[] Listed on the Contaminated Land Register (CLR) under the Environmental Protection Act 1994