07/0198 - Op Works - Prescribed Tidal Work - Retaining Wall [As Published] · 142007.198

INTEGRATED PLANNING ACT 1997

Part A, Version 2.2, 25 July 2005

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

Land owner's consent (if applicabie) 20. Land owner's consent to the making of this application:
A er tehe mere eee nade Name Signature Date
“ without the land owner’s consent,
An appicaton must be supported by te consent of ae eee ewe enn n anne anew nneennnnccnnnnnndececcc cece ccccccanecceccneccecc:|onseecceccese
ailland owner if the application involves:
0 ‘a material change of use;,
(@) reconfgurationofalth fl RTT weeaceesccccccccssseecreseer ye rrsccesseccceecccsrsrer arses s es peerencrcescce
(il) work on land below high-water mark & not within
a canal as defined under the Coastal Protection | uw r cers eer ecer rence nn rennrrne errr ere ce da nnn nen eeeea ncn n enn nn nnn sne ses bee wenn mene ee
and Management Act 1995:0r
(¥)_ work on rail corridor land definad under the \
: Transport infrastructure Act 1994, .
" For a mobile or temporary ERA - landowners :
consent is not required.
For more information refer to Guide 1,
i Sexson a2 140) a ce) vpesthat 21. Does this application involve taking or interfering with (other than interfering with quarry material on Stato:
fon (>) prescril lat an . ;
| applleation cannot be taen to be propery made coastal land under the Coastal Protection een 1998) a State resource? f
g Wout evidence of he resaurosentement NO - go to 024 ES - go to. 022
i Refer fo schedule * Wot the Integrated Planing ; 22. This application is required by regulation to be accompanied by evidence: (tick applicable box)
( reed by the Sia in support of te lodging of tis (1 (i) ofthe allocation of, or entitlement to, the resource - attach evidence i
fevelorment appfcaton. (ii) the chief executive of the department administering the resource is satisfied the development Is ‘
‘ consistent with an allocation of, or entitlement to, the resource - go to Q23 ’
(iii) the chief executive of the department administering the resource is satisfied the development
application may proceed in the absence of an allocation of, or entitlement to, the resource -
{ go fo. Q23 :
_ Advice tor completing. 023 ____ 123, Evidence of the resource entitlement:
{roafedinde G2) oyatoe "= |) Resource entitlement / authority details (v) Official stamp of the department
The official stamp of the Department of Natural [4 Sbotn Kiyer administering the resource (if =;
_ Resources and Mines is mandatory where the . applicable) ‘
* application involves taking or interfering with water or (i) Name of delegated officer
j riverine quarry material under the Water Act 2000, 2
i /KQ O oO .
(iii) Position of delegated officer :
(iv) Signature of delegated office '
(v) Date ol
CL a {iP 7?
Assessment triggers 24. Is the IDAS Assessment Checklist completed and attached to this application? '
hocomisierc hee sor eofeeromaaye Dyes (INO - the assessment manager may refuse to accept this appfcation on the
| must be completed for all other applications. grounds that the application has not been properly made
Plans / drawings / reports 25. Plans/drawings/reports accompanying this application:
supe ina rapoetl 8 erate bre oseactoert ° Plan / Drawing / Report Number Title Date | -
{ manager, referral agencies and any person viewing
* the apptication during public scrutiny or pubtic Wb 1 f .
Desoto cg sty ceutie | || I) LOLMOGE oo ooerereerrveeeeh Noes, Revere spt Renn ..28/ 7 [o¢
; and any potential impact. Dra whey §

 

 

 

 

 

 

 

 

PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of tadgement, fails to provide all applicable information required by Part A
and any other relevant part of Form 1.

 

OFFICE USE ONLY (appiicable fo assessment manager's)

 

 

 

— r DATE RECEIVING OFFICER'S REFERENCE
[FEE is] (Yoo | __RECEIVED | b/o4 o7 NAMES fy Kncemay NUMBERS. | | oO] I? |
Notification of Engagement of Private Certifier (Optional formas)
To, Council, { have been engaged as the private certifier for the building work referred to in this application.

 

Date ofengagement / /

Accreditation Number.

__ Name:

Signature: