Development Application part 1 of 2 IDAS Form 1 & 5 MCU11/0178

2. What type of approval is being sought?


    development permit

q   preliminary approval

q   both - provide details below



3. Is the application for a mobile and temporary environmentally relevant activity (ERA)?


     No
q    Yes - complete table A and then go to question 5




4. Location of the premises (complete table B and/or table C as applicable. Identify each lot in a separate row)

Table B - street address/lot for the premises or street address/lot on plan for the land adjoining or adjacent to the
premises

                                                                               Lot on plan
                  Street Address
                                                                               description
                                                                                                   Local government area
                  Unit Street       Street name and official         Post          Plan type         (e.g. Logan,Cairns)
                                                                          Lot No
                                                                              No.
                  No.   No.          suburb/locality name            code         and plan no.
                                Black Mountain Road, Black                                       SCRC
              1         332                                                2       RP 200503
                                Mountain

® Street address / lot on plan
  Street address / lot on plan for the land adjoining or adjacent to the premises (appropriate for development in
q water e.g. jetty, pontoon)
Table C - premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g.
channel dredging in Moreton Bay)

                  Coordinates (note: place each set of
                  coordinates in a separate row)                         Zone                           Local government
                                                                                       Datum
                                                                       reference                        area (If applicable)
                    Easting     Northing    Latitude     Longitude

                                                                                   q GDA94

                                                                                   q WGS84
              1                                                                    q other



5. Total area of the premises on which the development is proposed (indicate hectares or m2)

110500m2
6. Current use/s of the premises (e.g. vacant land, house, apartment building, cane farm, etc.)


          1       Existing House



7. Provide a brief description of the proposal (e.g. six unit apartment building, 30 lot residential subdivision etc.)


Annexed Unit used as farm managers dwelling (Under SCRC falls under Multiple Housing Type 1)




                                                                                               Application Details - IDAS form I
                                                                                                 Version 1.0 18 December 2009