OPW13/0859 Application for permit to damage vegetation 8 Bunya Lane Black Mountain

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          5. Are there any current approvals (e.g.a preliminary approval) associated with this application? (Non-
          mandatory requirement.)                                                                                                   ,




          D      No        D   Yes-provide details below

          List of approval reference/s                       Date approved (dd/mm/yy)            Date approval lapses (dd/mm/yy)




          6. Is owner’s consent required for this application? (Refer to notes at the end of this form for more information.)


          D      No


                 Yes-complete either Table G, Table H or Table I as applicable

  I       Table G

          Name of ownerls of the land
                                                    Nt c#eu-!rS            ...e...   MA-~A     6’~. _i..
          I/We, the above-mentioned ownerls of the land, ~ent to the making of this application.

          Signature of ownerls of the land
                                                                A                    ~ f?r        -




                                                                 t
          Date
                                               /~                         "yO/It:> /J~
  ~                                            "-                                    "   r



          Table H


          Name of ownerls of the land


          D The owner’s written consent is attached or will be provided separately to the assessment manager

          Table I

          Name of ownerls of the land


          D By making this application, I, the applicant, declare that the owner has given written consent to the making of the
          application.



          7. Does the applic tion involve a state resource? (E.g. the application involves taking water or qUarry    material, or
          interfering with the flow of water. Refer to the notes at the end of this form for more information) (Non-mandatory
          req uirement.)


          ~ No                     D      Not identified whether or       D    Yes-complete Table J
                                          not the application
                                          involves a State
                                          resource




          Table J

          Nature of state-owned resource (if identified)




          4                                                                                            IDAS form 1-Applcaton dela s
                                                                                                            Version 2.031 Marcf12013


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