07/1815 - Preliminary building works assessable against planning scheme [As Published] · 172007.1815

4)

INTEGRATED PLANNING ACT 1997

 

Land owner's ‘consent: (i applicable)

| Section 3.2.1(3) ofthe [PA prescribes tial an .
‘pplication must contain, of be supported by, the

involves: :

Li). material change of use,

(I) -reconfiguration of a lot

fii) work of land below high-water mark & nit within a

"| canal as defined under the Coastal Protection and
Management Act 1995,0r

‘IN) work on fall corridor land defined under the
Transport Infrastructure Act 1994...

* Section 3.8,1(2){a) of the IPA provides that

; landowner's consent is pot required for a moblig or

temporary ERA

For tore information refer ta Guide 1.

-aniten consent ofthe tand owners, {the epogaion te

  

 

   

Name
| qy “2 Conromron ax The
2-2 SSTMOO OF fet DUBE oF

 

ONS BANE

 

 

 

 

 

 

 

 

 

IST Seetepmmcngte oe NER mR oe
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E (v)

F Resource entitlement (if applicable) 21. Does this application involve a State resolirce prescribed under a regulation

Section 3.2.1(5) of the IPA requires evidence of yn on State coastal land. under the Coastal. Protection and Menagement Act 1998) .

| resource entitement be given for applications that :

involve a prescribed State resburce. NO -goto.Q24 Oo YES =;
pees tiranehde PArrescrbes at an 22. This application is accompanied ‘by evidence: (tick. appcabe box)

pivithout evidence ofthe oer he entitlement AQ of the allocation of, or entitlement to, the resource — attach eviderioe and go t0'025(u)

Rete to schedule 10 of the integrated Planning OW the chief executive of the department administering the resource is: Satisfied the:
Reguiation 1998 that prescribes the nature of evidence

paren te Stee i. ‘edging ons development Is-consistent with an allocation of, or entitlement to, ‘the oe

‘development appl : :

t Li (iii) the chief executive of the department administering the resource is satisied the.

' development application. may proceedin the absence of an allocatic of;or ss

[ entitlement to, the fesource- goto 023 a

i omptetiia G23 __.__ |23. Evidence of: the resource entitlement: Bo, * ae

Tei me a oe nandalory f evidence is (i) “Resource entitement/ aithority details“: _{vii) Official stamp of the:

{The oficial stamp of the Department of Natural . _ *+ administering

j Resources, Mines and Water is mandatory where the . — = <7 = applicable) -

F application Involves any water or riverine quarry
Fate! under the Water Act 2000

; Section 3.2. 1(5A) allows the resource manager to limit
‘ { the time the evidence may be used. Q23 (vi} must be
jeomplted if the evidence is fime limited.

  
  
 
 
  
   

   

 

 

 

 

 

 

 

 

 

 

 

 

Assesment triggers

the completion of Parts A and B of the Form only. tt
Must be completed for ail other applications.

This checkist does pot apply if the application ceninel :

 

 

 

Plans / drawings / reports

“An application should be aocompaniad by details to
Support the proposal & enable the assessment ~
‘manager, refetrel agencies end any person viewing
| the application during public scrutiny or public .
Rolification to understand the scope of the proposal ¢
jond any potential impact ao

 

at

 

25. Pianeldvawingaroporis accompanying | ‘this “pplication:

 
  

 

Title

 

Plan / Drawing / Report Number
. 2a MN CLESS
C-UL-l 2eve t Conve Osce. 3:9-o7

 

 

 

 

 

 

 

PLEASE NOTE: The assessment manager nay refuse to accept an application that, at the time of fodgement, fails to provide all applicable information required bye PartA

- and any other relevant part of Form 1.

 

FRE @)

OFFICE USE, ONLY (applicable to assessment menegers
‘DATE ©

 

\"

 

 

 

 

 

To

 

Aecrdtatn

- Notification of Engagement of Private Certifier (Optional formal)

  

Council, | have been engaged as the penal certifi for the building work refered toin his application,

 

_Name: Signature: ara

Number. -

 

 

Oateofengagement / /

:

- ’

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