Development application part 1 of 2 IDAS forms 1 & 6 · OPW13/0914

         Table F-premises coordinates (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.)(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

                                                                                         0 GDA94
                                                                                         0 WGS84
                                                                                         0 other
        4. Total area of the premises on which the development is proposed
                                                                                   (indicate square metres)



    I   902m2

                                                                                                                                      I
        5. Current use/s of the premises (e.g.vacant land, house, apartment building, cane farm
                                                                                                     etc.)



    I   House

                                                                                                                                      I
        6. Are there any current approvals (e.g.a preliminary approval) associated with this
                                                                                                    application? (Non-
        mandatory requirement.)

        X      No      0 Yes-provide details below
        List of approval reference/s                     Date approved (dd/mm/yy)              Date approval lapses (dd/mmlyy)




        7. Is owner’s consent required for this application? (Referto notes at the end of this form for more
                                                                                                             information.)

        X      No

        0 Yes-complete either Table G, Table H or Table I as applicable

        Table G

        Name of ownerls ofthe land

        IM/e,the above-mentioned ownerls of the land, consent to the making of this application.

        Signature of ownerls of the land


        Date


        Table H

        Name of ownerls ofthe land


        oThe owner’s written consent is attached or will be provided separately to the assessment manager

I       Table I


    4                                                                                                JDAS form 1-Application details
                                                                                                      Version 2.0 17December 2012