0014CBAC.001

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                INTEGRATED PLANNING ACT 1997                                                                                                    Part A, Version 2.4, 29 May 2006
                Land owner's consent (if applicable)         20.   Land owner's consent to the making of this application:
                application must contain, or be supported by, the                                                               a?)
                written consent of the land owner/s, if the application :                   J                                    yp                          é       3
                {i} a material change of use;                       O Biwepeton,                                   ee      LO bh MSL                 ee. C~ O20;
               involves:                                              '              .      | c                                                               ,        -o7,
                {ii) reconfiguration of a lot                                                                                                                                      .
                {ii} work on land below high-water mark & not within a {ii)                                                                                                   - ¥
                    canal as defined under the Coastal Protection and eS Sa
                    Management Act 1995;0r                            i
                (iv) work on rail coridor land defined under the     (iii)
                    Transport Infrastructure Act 1994.              wn ee ee        ee   ee     ee ee ee ee   ee ee eee ce ee eee ence eee eee eee bem e eee eeeee
                Section 3.8.1{2)(a) of the IPA provides that          .
                tandowner’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
                 Section 3.2.1(5) of the IPA requires evidence of  quany material on Slate coastal fand under the Coastal Protection and Management Act 1995)?
                 resource entiftement be given for applications that mn
                 involve a prescribed State resource.                   NO - go to 24                          L] YES - go to 22
                Section 3.2.1{10)(a)(@) of the IPA prescribes that an .      eer                    .         .
                application ont S aken to be property made   22.   This application is accompanied by evidence: (tick applicable box)
                  euneveence vane eB         a                     C1 {i)_  of the allocation of, or entitlement to, the resource — attach evidence and go to Q23(u)
                 Refer to schedule 10 of the integrated Planning   (1 (ii) the chief executive of the department administering the resource is satisfied the
                 Regufation 1998 that prescribes the nature of evidence                    i        j         i              i              i                           -
                 requited by the State hn support of the lodging of this   development is consistent with an allocation of, or entitlement to, the resource - go
     6           development application,
                                                                   ([} (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 023
               se        ea         ne    vdatory#  evidence | 23. Evidence of the resource entitlement:
                 required under a W) (i nencatony f evidence       (i)   Resource entitlement / authority     details              (vii) Official stamp of the department
                     Information In (f} — m:                        "                   :                 .        .                 a       .
                 The offical stamp of the Department of Natura                                                                         administering the resource (if
                 Resources, Mines and Water is mandatory where the                                                                     applicable
                 application involves any water of riverine quarry {i)   Name of delegated officer
                cern 32.164 aos he ea                                    Td
                 Section 3.2.1(5A) allows the resource manager to limit
                 the time the evidence may be used. Q23 (vi) must be iii     iti
                 completed the evkdonce fs ime Eriied              (ii)  Position of — officer
                                                                  (iv)    Pe        of ~ officer
                                                                    (v)  Date

                                                                   (vi)  pea date of evidence           a
                 Assessment triggers                          24.  ts the IDAS Assessment Checklist completed and attached to this application?
                theconpiefen ef PoE Ama boree Form ony 1            Vv | YES                     (J NO - the assessment manager 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:
       .        the application durin pubic scrutiny or public        (i)  OF      l2z0 ~—|                           6.      Coron                          Feo]
                 Manages, referral agencies and any person viewing     r
                notification to understand the scope of the proposal       ean seen conta          roo               OTT         TT re eae cencsanacnpe       sconces enn enn
                ard eny polenta impact.                               )     O1lZo0-2                                   G. Pator                                 2 6
                                                                      (i)                                                                        (hz
                                                                      Ce                                                              RA                        GX
                 PLEASE NOTE: The assessment manager may refuse to accept.an application that, at the time of lodgement, fails to prov AS? DoticalS EQ gy ven” MAT
                                    and any other relevant part of Form 1.                          .          '                                :          *               .
                OFFICE USE ONLY (appiicabio to assessment manager's                                                                                   SPR         2007     bee
                FEES                           |    eno | Mer]                                                                           Ne                              Ex)
                                                    RECEIVED                                 NAMEIS                      .           __JANUMBERISSTMRE   COtni ci —_/
                                                            Notification of Engagement of Private Certifier (Optional format}
                  To                                                        Council. | have been engaged as the private certifier for the building LIEN                at)
                                                                                                                       .                                          \
                  Date ofengagement     /    /    Accreditation Number:                    __ Name:                                 Signature: