Appendix A - DA Form 1 and Owner's Consent (003)

PART 2 – LOCATION DETAILS
 3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)
 Note: Provide details below and attach a site plan for any or all premises part of the development application. For further information, see DA
 Forms Guide: Relevant plans.
 3.1) Street address and lot on plan
     Street address AND lot on plan (all lots must be listed), or
     Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
 water but adjoining or adjacent to land e.g. jetty, pontoon; all lots must be listed).
           Unit No.        Street No.        Street Name and Type                                       Suburb
                           521               Elm Street                                                 Black Mountain
   a)
           Postcode        Lot No.           Plan Type and Number (e.g. RP, SP)                         Local Government Area(s)
           4563            1                 RP862537                                                   Noosa
           Unit No.        Street No.        Street Name and Type                                       Suburb
                           10                Rose Gum Road                                              Black Mountain
   b)
           Postcode        Lot No.           Plan Type and Number (e.g. RP, SP)                         Local Government Area(s)
           4563            2                 RP862537                                                   Noosa
           Unit No.        Street No.        Street Name and Type                                       Suburb
                           22                Rose Gum Road                                              Black Mountain
   c)
           Postcode        Lot No.           Plan Type and Number (e.g. RP, SP)                         Local Government Area(s)
           4563            3                 SP235191                                                   Noosa
 3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or adjacent to land
 e.g. channel dredging in Moreton Bay)
 Note: Place each set of coordinates in a separate row. Only one set of coordinates is required for this part.
     Coordinates of premises by longitude and latitude
 Longitude(s)                         Latitude(s)                      Datum                          Local Government Area(s) (if applicable)
                                                                            WGS84
                                                                            GDA94
                                                                            Other:
     Coordinates of premises by easting and northing
 Easting(s)                    Northing(s)            Zone Ref.        Datum                          Local Government Area(s) (if applicable)
                                                          54                WGS84
                                                          55                GDA94
                                                          56                Other:
 3.3) Additional premises
    Additional premises are relevant to this development application and their details have been attached in a
 schedule to this application
    Not required


 4) Identify any of the following that apply to the premises and provide any relevant details
     In or adjacent to a water body or watercourse or in or above an aquifer
 Name of water body, watercourse or aquifer:                                                         Six Mile Creek
     On strategic port land under the Transport Infrastructure Act 1994
 Lot on plan description of strategic port land:
 Name of port authority for the lot:
     In a tidal area
 Name of local government for the tidal area (if applicable):

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                                                                                                        DA Form 1 – Development Application details
                                                                                                                      Version 1.1— 22 JUNE 2018