00154413.001

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            INTEGRATED PLANNING ACT 1997                                                                                                    Part A, Version 2.4, 29 May 2006
      My     Land owner’s consent (if epplicable)         20.  Land owner's consent to the making of this application:
            sotsion nus   cot, be srpred by, pName                                             | Signature                                            |       ate
             application must contain, or be supported Oye                                                           _—)
             vee                                                        ROGER            LE                               aw           Nae
            written consent of the land owners, if the application            ~
             () amaterid change of use;                         ORGOER LEVER                                   © [tex PN SAH [AUS [07
             {i} reconfiguration of a lot                         . p                                                       r
             1 Sard 2 defied under the Coastal Protection and    MOTAMELA LEVER © Fe an thon                                          Kru                at. To)
             iii) work on land below high-water mark & not within a ll                                                                                           —       t
                Management Act 1995,0r
             {1¥) work on rail corridor land defined under the   {iii)
               Transport Infrastructure Act 1994.               we ee                                 eee eee oe          eee ee ee ewe ee eee wee bec ecw ne ences
             Section 3.8. 1(2){a) of the IPA provides that        .
             landowner's consent is not required for a mobile or {iv)
            For more information refer to Guide 1,               (v)
             Resource entitlement (if applicable)         21.  Does this application involve a State resource        prescribed under a regulation (other than involving
                                                                                                                   Pp                       g
             Section 3.2.1(5) of the IPA requires evidence of  quarry material on State coastal land under the Coastal Protection and Management Act 1995)?
             resource entitlement be given for applications that
             involve a prescribed State resource.              EX] NO - go to Q24                         1] YES - go to Q22
             Section 3.2,1(10   f the IPA prescribes that         .      Lo                     .         .
             appiicaton cannat to taken to be property made 22. This application is accompanied by evidence: (tick applicable box)
            whee vie              ee                          {    (i)  of the allocation of, or entitlement to, the resource — attach evidence and go to Q23(v)
             Refer to schedute 10 of the integrated Planning   {_] (ii) the chief executive of the department administering the resource is satisfied the
             Reguiation 1998 that prescribes the nature of evidence                    i        i         i              i              j                           -
             cenied by the State in support ofthe alg of Ce            development is consistent with an allocation of, or entitlement to, the resource - go
 @           development application.                                          .          .                             .     .                  :
                                                               (J (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 to Q23
             eee otcommietina 2                           23.  Evidence of the resource entitlement:
                 ,     son in ti) ~ fv) is mrandetore tfevidenca t                  °                 :        .                 w      .
             ngivienecsieiiee                                  (i)   Resource entitlement / authority     details              (vii) Official stamp of the department
             The official stamp of the Department of Natural                                                                       administering the resource (if
             Resources, Mines and Water is mandatory where the  .                                                                  applicable,
             application involves any water or riverine quarry (ii)  Name of delegated officer
             certon 32.   als te en                                  TY
             Section 3.2.1(5A) allows the resource manager fo limit
             the time the evidence may be used, 023 (vi} must be i       iti
             completed if the evidence is time limited.       (il)   Position of delegated officer
                                                              (iv)   P         of ~ Officer
                                                                {v)  Date
    @                                                          (vi)  _ date of evidence f eee
             Assessment triggers                          24,  Is the IDAS Assessment Checklist completed and attached to this application?
            Thi       t              if     icati    i                                                                                                    eg
             the completion of Pare sei polte roman            XX] YES                       [_] NO - the assessment menager may refuse to accept this application 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:
             An    applicati             ied by detail                                                                             .
             manager, referral agencies and any person viewing     .
             the application during public scfutiny or public   (i)     00770-1-A                                 Proposal Report                         May 2007
             notification to understand the scope of the propasal Tem wee ores eee e eee nsec sere ec seresscces weer eeeaewewcrcr rer srccs crew ee poses eresrres
             and any potential impact.                            (ii)
                                                                  (iii)
                                                                  (iv)
             PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide all applicable information required by Part A
                                 and any other relevant part of Form 7.
                                                                                                                nT
             OFFICE USE ONLY (applicable to assessment manager's
                                                  DATE                             RECEIVING OFFICER'S         :       |              REFERENCE
             Fe       2570.00           | _necenen          |3/-S-07                                     Suoptr Herre _| "rowsens [7007/1022
                                                        Notification of Engagement of Private Certifier (Optionat format)
              To                                                        Cuincil. | have been engaged as the private certifier for the building work referred to in this application.
              Date ofengagement:    /    /    AccreditationNumber__o ===                 Names                                  CSignattures_