Development Application for permit to damage vegetation - 15 Blackbean Court Black Mountain · OPW12/0394

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                  DDD
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                                                                                                                                                             Zone                                            Datum                                    Local government
 (note: place each set of coordinates in a separate row)                                                                                                                 reference                                                                                area      (if applicable)

 Easting                                               Northing                        Latitude                              Longitude



                                                                                                                                                                                                                          D GDA94
                                                                                                                                                                                                                          D WGS84
                                                                                                                                                                                                                          D other


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                         No
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  D Yes-complete either table D, table E                                                                        or   tabl~ F as applicable

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 Table 0


 Name of owner/s of the land


 I/We, the above-mentioned owner/s of the land, consent to the making of this application.

 Signature of owner/s of the land



  Date




                                                   3                                                                                                                                                                                   Application details-IDAS form 1
                                                                                                                                                                                                                                             Version 1.0 18 December 2009