Operational Works Application OPW17/0039

                                                                              Department of Infrastructure, Local Government and Planning


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

GY      No          o     Yes-provide        details below


List of approval reference/s                                 Date approved (dd/mm/yy)                Date approval lapses (dd/mm/yy)



6.      Is owner's      consent   required     for this application?      (Refer to notes at the end of this form for more information.)


o No
QI     Yes-eomplete        either Table F, Table G or Table H as applicable


Table F

Name of ownerls of the land

l/lNe, the above-mentioned        ownerls of the land, consent to the making of this application.

Signature of ownerls of the land


Date

Table G

Name of ownerls of the land                         I(L
       The owner's written consent is attached or will be provided separately to the assessment manager.

Table H

Name of ownerls of the land                    I
o By making this application, I, the applicant, declare that the owner has given wrilten consent to the making of the application.
7.       Identify   if any of the following        apply to the premises      (Tick applicable box/es.)


o Adjacent to a water body, watercourse or aquifer (e.g. creek, river, lake, canal)-compiete Table I
o On strategic port land under the Transport Infrastructure Act 1994-complete Table J
o In a tidai water area-eomplete Table K
o On Brisbane core port land under the Transport Infrastructure Act 1994 (No table requires completion.)
o On airport land under the Airport Assets (Restructuring and Disposal) Act 2008 (no table requires completion)
o the
  Listed on either the Contaminated Land Register (CLR) or the Environmental Management Register (EMR) under
       Environmental Protection Act 1994 (no table requires completion)

Table I

Name of water body, watercourse or aquifer




                                                                                                            IDAS form 1-Application details
                                                                                                             Version 4,3-5 December 2016