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

                                                                                                  \




"8~ldentify’i(any?of the foll wing                   Piy to the pr:~is:s (rick applicable box/es.)

    D        Adjacent to a w’at r body, watercourse or aquifer (e.g. creek, river, lake, canal)-complete Table K

    D        On strategic port land under the Transport Infrastructure Act 1994-complete Table L


    D        In a tidal water area-complete Table M


    D        On Brisbane co’re port land under the          Transportlntrastructure Act 1994 (notable requires completion)
    D        On airport land under the Airport Assets. (Restructuring and Disposal) Act 2008 (no table requires completion)



Table K                                                                    .
                                                                               ,




Name of water body, watercourse or aquifer                                                                                ,




Table L

Lot on plan description for strategic port land                                            Port authority for the lot




Table M

Name of local government for the tidal area (if applicable)                                Port authority for the tidal area (if applicable)




                                                                           ~                                                                        .                .


,9. Are there any existing easements on the premises? (e.Q. for vehicular access, electricity, overland flow, ~~ter
                                                                                           ’~.
                                                                                                                                                    .




,t;tc.)      .
                  ,;;",:1’ ,~;;
                          ..   H
                                   ’t              ~? ’II              ~.
                                                                                       III
                                                                                                ~7
                                                                                                           Bb,,"


    D        No           D        Yes-ens.ure the type, location and dimension of each easement is included in the plans submitted

                                                                                                               .,..                                         .w.
                 ~
                                                            ~                                                                                                     :!’I1~
~JiI;;   ,
                     ~




;10. Doe~the proposal include new building work or operational work on the premises? (In luding any service~.)

    D        No           D        Yes-ensure the nature, location and dimension of proposed works are included in plans submitted


                                                                                                                                                                           "
                     ’U

.i:ifls,th, p y;ri1:’l f a port ble long servi~e,: ave leVy appli~a’b                          et     this   appiitatio~’? (Ref~~1Q" ~te~Aafth~ e~
                                                                                                                                  It
.




    of this form’for more information.)
                                                                "                  .   -
                                                                                                                               ,




                                                                                                                                   If’
                                                                                                                                                   11" 1$
                                                                                                                                                        ~




    X    No-go to question 1.3.                    DYes

    12. Has the portable long serv,ice leave levy been paid? (Refer to notes at the end                               oithiS’for~for m J:     ~
                                                                                                                                                        .




                                                                                                                                                              UIWJ
    information..)
                                                                                                                                             II!
                                                                                                                                                        .~u~~i:
    D        No


    DYes-complete T ble N and submit with this application the yellow local government/private certifier’s copy of the
             receipted QLeave form

Table N                                                                   ,




Amount paid.                           Date paid        QLeave project number (6digit number starting with A, B, E, L or P)
                                                                                                                                         ,




                                       (dd/mm/yy)



5                                                                                                                         IDAS form 1--..Appfcat on dotails
                                                                                                                               Version 2.031 March 2013