09/1511 - Reconfiguration (Realignment of Boundaries) [As Published] · 152009.1511

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008
Table D Complete if the premises are adjacent to or associated with a water body, watercourse or aquifer (e.g. river, creek, lake, canal)

Table E Complete if the premises are on Strategic Port Land under the Transport Infrastructure Act 1994

Table F Complete if the premises are in tidal water

 

Name of water body, watercourse or aquifer (if known)

 

[1

 

 

Lot on plan description for strategic port land Port Authority for the lot

 

[1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of local government for the'lidal area (if applicable) ~ Name of port authority for the tidal area (if applicable)
1
3. Indicate the total area of the premises on which the devetopment is proposed: (Note: The total area may include land both ebove and below water)
Total area of premises
6.55 (C]m? [X]hectares (Tick applicable unit
Existing use of the premises |
4. — Current use/s of the premises: (e.g. vacant land, house, townhouses, apartment building, shop, service station, school, sugar cane farming etc.)
{1 | Dweling house & vacant |
5. Are there any existing easements on the premises? (e.g, for vehicular access, electricity, overland flow, water etc.)?
Oo No Yes - Ensure the type, location and dimensions of each easement are included in plans, submitted with the application
[Proposal details.” BE oe ne ee
6. Brief description of the proposal (e.g. 6 unit apartment building, 30 fot residential subdivision, a bore, aquaculture)
Realignment of common boundaries
7. Does the poposal include new buildings or operational work (including any services) on the premises?
No C) Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application
‘Resource entitlement (if applicable) -- further information is provided in the advice section at the end of the form 1
8. Does the application involve taking or interfering with a State resource and therefore require a resource entitlement? (e.g. the application
involves State land (leased and freehold), declared Fish Habitat areas, taking quarry material, taking or interfering with water under the Weter Act 2000, etc.)
No -GotoQ9 Oo Yes - Complete Table G - provide details for each evidence required on a separate row, if applicable. Evidence of resource
allocation or entitlement must be submitted with the application. You do not need to answer Q9 - go to the next section.
[Owner's consent (if applicable) - further information is provided in the advice section at the end of the form |
9. Complete Table H for applications involving a material change of use; reconfiguration of a lot; work on land below high-water mark and
not within a canal as defined under the Coastal Protection and Management Act 1995; or work on rail corridor land defined under the
Transport Infrastructure Act 1994 - provide details for each owner on a separate row, or on an attachment to this form if applicable.
Premises Owner's names ‘| - Details of the premises owned sas . Date consent
Table H and postat address |-__—_(ireet-adtdress or lat on plan description) + Owners signature "was obtained
1 Michelle M Frith 210 & 212 Lawnville Road, Black Mountain - . .
J ABST aG
2 Dean L Frith 210 & 212 Lawnville Road, Black Mountain ST 2 g .

 

 

 

 

 

 

 

 

 

* Owner's signature cannot be provided on the form if you intend to submit the application electronically. Owner's consent must be provided to the assessment manager on an

attachment containing appropriate written documentation of the owner’s consent. If the owner is a company, $127 of the Corporations Act 2001 (Cwealth) details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .