img012.jpg · OPW13/0706

ZL

 

 

 

 

 

 

 

 

Table K JL
Name of local government for the tidal area (if applicable) Port authority for the tidal area (if applicable)
Z
8. Are there any existing easements on the premises? (e.g. for woe access, electricity, overland flow,
water etc)

 

[J No CJ Yes—ensure the type, location and dimension teat easement is included in the plans submitted

 

9. Does the proposal include new building work or oer work on the premises? (Including any
services)

 

C] No C] Yes—ensure the nature, location and erst of proposed works are included in plans submitted

 

 

10. Is the payment of a portable long service leave levy applicable to this application? (Refer to notes at the
end of this form for more information.)

 

 

[_] No—go to question 12 [] Yes /

 

 

11. Has the portable long service leave/levy been paid? (Refer to notes at the end of this form for more
information.)

 

 

[_] No

L] Yes—complete Table L and sujsmit with this application the yellow local governmentprivate certifier’s copy of the
receipted QLeave form

 

Table L /

 

Amount paid / Date paid QLeave project number (6 digit number
(dd/mm/yy) starting with A, B, E, L or P)

 

 

 

 

 

 

12. Has the local government agreed to apply a superseded planning scheme to this application under
section 96 of the Sustainable Planning Act 2009?

 

 

é
/

[-] No f

C] Yes—pleage provide details below
ZL

 

Name of local government Date of written notice given | Reference number of written notice given
by local government by local government (if applicable)
/ (dd/mm/yy)

 

 

 

 

 

[

 

IDAS form 1-

ars