10/0574 - MCU [As Published] · 132010.574

ooo

 

 

18: 18 owner's.consent required for this application? (refer.to notes at the end of this forn for more information) . = |

 

(J No

&] Yes - complete either table D, table E or table F as applicable

 

Table D (note: do not complete this table if lodging the application on-line using Smart eDA)

 

 

 

Name of owner/s of the land _—|See attached letter

 

UWe, the above-mentioned owner/s of the land, consent to the making of this application.

 

Signature of owner/s of the land

 

 

Date

 

 

Table E

 

@ Name of owner/s of the land

 

 

 

[J The owner's written consent is attached or will be provided separately to the assessment manager

 

Table F

 

 

Name of owner/s of the land

 

 

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

 

 

 

9: Does the application involve a state resource? (e-g. the application involves state‘land, or taking

 

  

 

materials. Refer to the riotés. at'thé end of this form for more information) -

 

 

 

(Yes - complete table G

 

 

 

 

of the following apply to:the premises (tick applicable boxes):

 

(1 | adjacent to a water body, watercourse or aquifer (e.g creek, river, lake, canal) - complete table H
[] _ onstrategic port land under the Transport infrastructure Act 1994 - complete table |
CJ _ ina tidal water area - complete table J

 

are any existing easements on the premises

 

 

   

 

[XINo [1] Yes - ensure the type, location and dimension of each easement is included in the plans submitted

 

Application Details - IDAS form 1
Version 1.0 18 December 2009