Development Application for permit to damage vegetation - OPW13/0405

Table C-Additional aspects of the application (If there are additional aspects to the application please list in a
separate table on an extra page and attach to this form.)

        D Refer attached schedule         D Not required


~Location of the premises (Complete Table E and/or Table F as applicable. Identify each lot in a separate row.)
                address and 101 on plan for the premises or streel address and 101 on plan for the land adjoining or

T.b~treel
adjace to the premises. (Note:this table is to be used for applications involving taking or interfering with water).
(Attach a eparate schedule if there is insufficient space in this table.)
       0               and 101 on plan (Alllols must be lisled.)


             s~ess
       D Street ddress and lot on plan for the land adjoining or adjacent to the premises (Appropriate for
             develop      nt in water but adjoining or adjacent to land, e.g. jetty, pontoon. All lots must be listed)

Street address
                          ~                                                  Lot on plan
                                                                             description
                                                                                                               Local government area
                                                                                                               (e.g. Logan, Caims)
Lot        Unit     Street
            no.     no.
                                ~~me
                                subu
                                             and official
                                         locality name
                                                                 Post-
                                                                 code
                                                                             Lot no.       Plan type
                                                                                           and plan no.


i)                                         "’"
ii)                                          ~
iii)                                                 ~
Planning scheme details (If the premises
separate row in the below table. Non-mandatory.)  involves~e             zones, dearly identify the relevant zone/s for each lot in a


Lot        Applicable zone/precinct                 Applicable   locai~/precinct                     Applicable overlay/s
i)                                                                       "’"
ii)                                                                          "’"
iii)                                                                             ~
                                                                                              ""’"
Table F-Premises coordinates (Appropriate for development in remote areas, ov                              of a lot or in water not
adjoining or adjacent to land e.g. channel dredging in Moreton Bay.) (Attach a separate schedule if there is insufficient
space in this table.)

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


3. Total area of the premises on which the development is proposed (indicate
                                                                                                     square metres)

             ~ (, fJ-G~S.
4. Current use/s ofthe premises (e.g. vacant land, house, apartment
                                                                                       building, cane farm etc.)


I C41r/Lt ~
              3
                                                                                                 Application details-IDAS form 1
                                                                                                        Version 2.0 31 March 2013