06/1266 - Op Works Transport Type 5 Domestic Marine [As Published] · 142006.1266

INTEGRATED PLANNING ACT 1997

Land owner's consent (ifapplicabie)
Seétion 9.2/4( 10} ofthe IPA presetibgs tal an

  
  

  
  

8 land oymer's consent eae

‘Must be supported byt the consent é
‘Mand ‘over if the application involves:

{) a material change of use;

(il) Teconfiguration of a lot;

(i) work.on land below high-water mark & not within
@ canal as defined under the Coastal Protection
‘and Management Act 1995;0r

work on rait corridor land defined under the
Trinsport infrastructure Act 1994.

For a mobile or temporary ERA - landowner's
consent is lof required.

(Ww)

20.. and owner's consent-to the makirig of this application:

Part A, Version 2.2, 25 July 2005

 

Z Signature

 

 

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For more information rater to Guide 1.
Sena toa (anpkeate) 21. Does this application involve taking or interfering with (other than interfering with quamry material on State
application ante er ee coastal fand under the Coastal Protection and Management Act 1996) a State resource?
withdut evidence of the resource entitlement BENO - g0 to 024 . LIYES - goto. 022
Fee Een Aol oan anne 22. This application is required by regulation to be accompanied by evidence: (tick applicable box)
lal prescnoes: nature of evidence rn 1 1
required by the Sian support of the lodging of this (1 (i) of the allocation of, of entitlement to, the resource ~ attach evidence
development appicaton, L (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
D7 iil) 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 to Q23
Advice tor completing 023 _____ | 23. Evidence of the resource entitlement:
Tho efomatonin()-W ismandatny evidence ® |) Resource entitlement /authorty details (v) Official stamp of the department @
‘The offical stamp of the Department of Natural administering the resource (if
Resources and Mines is mandatory where the a applicable)
application involves taking oF interfering with water or (i) Name of delegated officer
eee an eestor Cd
(iii) Position of — officer
(iv) Signature of delegated officer
(v) Date
Assessment triggers. | 24, Is the IDAS Assessment | Checklist completed and attached to this application?

This checklist does not apply if the apptication requires
the completion of Parts A and Bof the Form gnly. St
must be comipleted (or all other applications.

oO YES

a NO - the assessment manager may refuse fo accept this application on the
grounds that the application has not been properly made

 

 
 
 
    

‘not ication to understand tha scope of the proposal
and-any potential impact.

 

aris/drawings/raports accompanying this application:

 

Plan { Drawing / Report Number

Date

 

 

 

 

 

 

 

 

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

 

OFFICE USE ONLY (applicable to assessment manager's
10,

 

 

 
 

  

H SEEMS oe SY

[fe ‘REFERENCE,
SRUMBERIS “

 

To.

 

Dateofengagement { |

 

Accreditation Number.

_— Name.

Notification of Engagement of Private Certifier (Optional format)
- Council. | have been engaged as the private certifier for the building work referred to in this application.

Signature: