OPW14/0010 - Vehicle Crossover application -

r-   ---




      Table K

      Name of local government for the tidal area (if applicable)         Port authority for the tidal area (if applicable)



      8.       Are there any existing easements on the premises?      (e.g. for vehicular access. electricity. overland flow,
               water etc)

      ~             0     Yes-ensure   the type, location and dimension of each easement is included in the plans submitted

      9.       Does the proposal include new building work or operational       work on the premises? (Including any
               services)

      ~             0 Yes-ensure       the nature, location and dimension of proposed works are included in plans submitted

      10.      Is the payment of a portable long service leave levy applicable       to this application?   (Refer to notes at the
               end of this form for more information.)

      [J/N~o          to question 12     DYes

      11.      Has the portable long service leave levy been paid? (Refer to notes at the end of this form for more
               information.)

      o     No

      o     Yes-complete Table L and submit with this application the yellow local government/private certifier's copy of the
            receipted QLeave form

      Table L

      Amount paid                                                     Date paid           QLeave project number (6 digit number
                                                                      (dd/mm/yy)          starting with A, S, E, L or P)




      12.      Has the local government agreed to apply a superseded       planning scheme to this application         under
               section 96 of the Sustainable PlannIng Act 2009'1

      ~o
      o     Yes-please     provide details below

      Name of local government                        Date of written notice given      Reference number of written notice given
                                                      by local government               by local government (if applicable)
                                                      (dd/mm/yy)




                                                                                                       IDAS lorm I-Application   de/ails
                                                                                                               Version 3.0-1 July 2013