PA Action St ERA ESR-2015-1791 Completed 02-2023

Application form

Development application Form 1 - Application details—attachment for an
application for an environmental authority

The fields marked with an asterisk * are mandatory, if they are not completed then your application may

be considered not properly made under the Planning Act 2016.

1. Applicant details

To nominate a site or application contact for this application please provide details at Questions 14 and 15.

 

Is there more than one I No—provide applicant's details below.

 

applicant? * (0 Yes—provide the principal applicant's details below and all other applicants’
details in Attachment 1—“Joint applicants and appointment of principal applicant”

 

Name - individual or contact person if applicant is a organisation*
Robert Watson

Suitable Operator Reference
Number*

 

Organisation name, including any trading name (*if an organisation)
Provectus Algae Pty Ltd

ABN/ACN (‘if an organisation)
82 625 465 572

 

 

As Above

Residential or registered business address (not a post office box)* Phone*
14 - 16 Action Street, Noosaville, Qld 4566 07 5474 1504
Postal address (if same as above, write “AS ABOVE”)* Facsimile

 

Email*
[email protected]

 

X Indicate if you want to receive
correspondence via email

 

1.1 Nomination of an agent for this application

application.

/we nominate the below agent to act on my/our behalf and to receive correspondence relating to this

 

Do you want to nominate an agent for this application?”
No — Go to Question Error! Reference source not found.
CJ Yes — Complete the agent's details here.

 

Name of agent — individual or contact person if agent is an organisation

 

Organisation name, including trading name if an organisation

ABN/ACN (if an organisation)

 

Postal address

Phone

 

Email

 

 

O Indicate if you do not want to
receive correspondence via email

 

2. Details of the ERA(s) that you want to operate
Please list all of the ERAs that will be undertaken on site, including:

e Any existing ERAs will continue to operate unchanged on the site (select “Existing” in the table below);
e ERAs that are proposed to be undertaken on the site as part of the application (select “New - DA” in the

table below); and

e ERAs that are proposed to be undertaken on this site, that don’t form part of this application as they do

not require a DA (select “New - EA” in the table below).

Listing all the ERAs that will be undertaken on site will help enable them to all be included on the one EA

 

Page 3 of 12 + ESR/2015/1791 + Version 8.00 + Last reviewed: 12 AUG 2021

Department of Environment and Science