08/1927 - MCU - Detached House - Part 1 [As Published] · 132008.1927

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1,3 March 2008

2. _ Identify if any of the following apply to the premises by completing Tables D, E, or F. (Note: in most instances, the premises will not involve any of the
following characteristics, however some applications may involve one or more of these characteristics - complete only if applicable)

Table 0 Complete if the premises are adjacent t to or associated with ¢ a water tbody. watercourse or aquifer (e.g. river, creek, fake, canal}

 

 

 

 

 

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4. Current uses of the premises: (e.g. vacant land, house, townhouses, apartment buiiing, shop, service station, school, sugar cane farming etc.)

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5. Are there any existing easements on the premises? (e.9. for vehicular access, electricity, overland flow, water eft.)
LI No EEYTES - Ensure the type. localion and dimensions of each easement are included in plans, submitted with the application

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7. Does the proposal include new building work or operational work (including any services) on the premises?
O No CtYes - Ensure the nature, location end dimensions of the proposed works are included in "las, submitted wilh the application

sures Entitlement Feidshoe nestor eorovdedt Nea

ree ene le ment Ee ANOT

‘Does the application involve taking or interfering with a State resource 2 and erste require a resource entitlement? (eg the application

   
  

   

 

 

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involves State land (leased and freehold), declared Fish Habitat areas, taking quarry material, taking or interfering with water under the Water Act 2000, efc.)
ito ~ Goto Q9 oO Yes - Complete Table G - provide details for each evidence required on a separate row. if appliceble. Evidence of resource allocation or
entitiement must be submitted with the application. You do not need to answer Q9 - go fo the next section.
Table G
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Owner's congent (ita sicabie) ihe advice secticn-at the ef of thé-orm,

9. Complete Table H for applications involving a material change of use; reconfiguration of a lot; work on land below high- water mark and. not
within a canal as defined under the Coastal Protection and Management Act 1995; or work on rail corridor tand defined under the
Transport infrastructure Act 1994 - provide details for each owner on a seperate row. or on an attachment to this form if applicable.

 

Table H Premises Owner's name/s Details of the premises owned Owners signature* Date consent
and postal address {sireet address or fot on plan description) : was obtained

 

 

 

 

 

 

 

* Owner's signature cannot be provided on the form if you intend to submit the application electronically. Owner's consent must be provided to the assessment manager on an
attachment containing appropriate written documentation of the owner's consent. {f the owner is a company, $127 of the Corporations Act 2001 (Cwealth) details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .

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