Development Application for Permit to Damage Vegetation 116 Blueberry Drive Blackmount · OPW13/0344

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            Table C-Additional aspects of the application (If there are additional aspects to the application please list in a
            separate table on an extra page and attach to this form.)

                     o Refer attached schedule                                     0 Not required

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             !br;                If;:                  ~ <;’{:   ,

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            ~-2. Location of the premises ( omplete Table E and/or Table ~a~ applicable. Identify each lot tr a separate row.)
                                                                                                                                                                                                                    .




            Table E-Street address’and lot on plan for the premises or street address and lot on plan’for the land adjoining or
            adjacent to the premises. (Note:this table is to be used for applications involving taking or interfering with water):
            (Attach a separate schedule if there is insufficient space in this table.)

                    D         Street address and lot on plan (All lots must be listed.)

                    D     .




                              Street address and lot on plan ’for the land adjoining or adjacent to the premises (Appropriate for
                              development in water but adjoining or adjacent to land, e.g. jetty, pontoon. All lots must be listed)
            Street address                                                                                      Lot on plan                                   Local government area

                                                                           I                                    description                                   (e.g. Logan, Cairns)

            Lot           Unit               Street              Street name and official            Post-      Lot no.               Plan type.

                          no.                 no.                suburb/locality name                code                             and plan no.



            i)                               116                 BLUEBERYY DRIVE                     4563                             AS SHOWN                SUNSHINE COAST
                                                                 BLACKMOUNT                                                           ON RATES                COUNCIL
                                                                                                                                      NOTICE

            ii)

            iii)

            Planning scheme details (If the premises involves multiple zones, clearly identify the relevant zone/s for each lot in a                  ,..




            separate row in the below table. Non-mandatory.)
            Lot           Applicable zone/precinct                                         Applicable local plan/precinct                             Applicable overlay/s

            i)

            ii)
            iii)


            T ble F-Premises coordinates (Appropriate for development in remote areas, over part of a lot or in water not
            adjoining or adjacent to land e.g. channel dredging in Moreton Bay.) (Attach a separate schedule if there is insufficient
            space in this table.)

            Coordinates                                                                                           Zone                       Datum                  Local government

            (Note: place each set of coordinates in a separate row.)                                              reference                                         area   (if applicable)

            Easting                     Northing                           Latitude            Longitude

                                                                                                                                              0 GDA94
                      ,
                                                                                       ,
                                                                                                                                              0 WGS84
                                                                                                                                              0 other
                                                                                                                                                                                          III
                                                                                                                                                                                                   ~

            3~ Total ~rea of the premIses on which the development is proposed (indicate squar~ metres)

            2 LARGE TREE, ONE SITUATED AT THE FRONT AND ONE SITUATED AT THE REA’R OF THE RESIDENCE
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            4. Cutrent use/s of the premises (e.g. vacant land, house, apartment building, cane farm etc.)                                                                                             ill




        I   HOUSE




                                 3                                                                                                                Application details-/OAS form 1
                                                                                                                                                          Version 2.031 March 2013




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