08/0749 - Op Works - Dam [As Published] · 142008.749

INTEGRATED PLANNING ACT 1997 : Part A, Version 3,1, 3 March 2008
Table D Complete if the premises are adjacent to or associated with a water body, watercourse or aquifer (e.g. river, creek, lake, canal)

 

Name of water body, watercourse or aquifer (If known)

 

[1 [wa

 

Table E Complete if the premises are on Strategic Port Land under the Transport Infrastructure Act 1994

 

Lot on pian description for strategic port land Port Authority for the lot

 

[1 [wa

 

Table F Complete if the premises are in tidal water

 

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

 

 

 

 

[4 [Na

 

3. Indicate the total area of the premises on which the development is proposed: (Note: The total area may include land both above and below water)

 

Total area of premises

 

8.00 LJ? hectares (Tick applicable unit)

 

 

 

 

 

Existing use of the premises ]

 

4. Current use/s of the premises: (e.g. vacant land, house, townhouses, apartment building, shop, service station, school, sugar cane farming etc.)

[1 | VACANT LAND |

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

 

& No O Yes - Ensure the type, location and dimensions of each easement are included in plans, submitted with the application
Proposal details ]

 

 

6. Brief description of the proposal (e.g. 6 unit apartment building, 30 Jot residential subdivision, a bore, aquaculture)

 

Development Permit for Operational Works - Dam Construction

 

 

 

7. Does the poposal include new buildings or operational work (including any services) on the premises?
No Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application

 

[Resource entitlement (if appicab’e) further information is provided in the advice section at the end of the form ]

 

8. Does the application involve taking or interfering with a State resource and therefore require a resource entitlement? (e.g. the application
involves State land (leased and freehold), declared Fish Habital areas, taking quarry material, taking or interfering with water under the Water Act 2000, etc.}

&) No - Goto a9 oO Yes -Complete Table G - provide details for each evidence required on a separate row, if applicable. Evidence of resource
allocation or entitlement must be submitted with the application. You do nat need to answer Q9 - go to the next section.

 

Owner's consent (if appiicable) - further information is provided i the advice section at the end of the form *

9. Complete Table H for applications involving a material change of use; reconfiguration of a lot; work on land below high-water mark and
not within a canal as defined under the Coastal Protection and Management Act 1995, or work on rail corridor land defined under the
Transport Infrastructure Act 1994 - provide details for each owner on a Separate row, or on an attachment to this form if applicable.

 

 

Date consent

Premises Owner's name/s Details of the premises owned
Table H .
was obtained

‘ .
and postal address (street address or lot on plan description) Owner's signature

 

 

1 NIA

 

 

 

 

 

 

 

* Owner's signature cannot be provided on the farm if you intend to submit the application electronically. Owner's consent must be provided to the assessment manager on an
attachment containing appropriate written documentation of the owner's consent. If the owner is a company, $127 of the Corporations Act 2001 (Cwealth) details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .

 

F . -
‘Attachments and supporting information (Compiete Table! - Use a separate row for each type of attachment or information, including information required
tunes this Part) Please ensure all documentation submitted with this form, inckxding other Parts of Form 1, or owner's consent, etc, are securely attached to this Part of the Form.

 

 

Description of attachment or information — Ti . .
itle (if applicable) Method of delivery to
Table | feg. Pan c of Form . omar consent entece of resource (e.g. Geners! Aahoniy. James Sveet Trafic Repo) Date essment manager