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

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Table I                                        Lot on plan description for strategic port land                                                                                                                                            Port authority for the lot




Table J                                          Name of local government for the tidal area (if applicable)                                                                                                                              Port authority for the tidal area (if applicable)




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 ~ No                                            D Yes-ensure the type, location and dimension of each easement is included in the plans submitted

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    E1 No                                        D Yes-ensure the nature,.location and dimension of proposed works                                                                                                                                                               are included in                         plans submitted

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    0’No-go                                       to question 15
                                                                                                                               D. Yes

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    D                           No


    D Yes-complete table K,and submit with this application the yellow local government/private certifi,er’s copy of the
                                receipted QLeave form


 Table K                                         Amount paid                                                                                Date paid                                                              QLeave Project Number (6 digit number starting with A, 8,
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 15. H s tHe local go}~ernoien(ag(eed                     tQ apply a supersed~d plannmg;sche,                                                   e.to this’appJlcatlon ync;ler sect(on 9 ’Qtff.
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                                No


      D Yes-please provide details below

    Name of I?cal government                                                                                                                                            Date ofwritten notice given                                                             Reference number of written notice given

                                                                                                                                                                        by local government                                                                     by local government (if applicable)




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