MCU15/0086 - IDAS Form 1 - Village Bicycle

application ~ owners slgnature.jpeg                                                                                                                                4/09/2015 12:03 pm




                                                                                                         o      rlmt'nt of Infrastruclure.local Go rrtRlcnt'l   d Planninjl:
                                                                                                                - ----

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


                                           No               Yes-provide     details below

                                                                                      Date approved    (ddlmml           Date approval lapses (ddl
                                 List of approval referencels                                                            mmlyy)
                                                                                      yy)




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


                                           No
                                      (    ves=;complete        either Table F. Table G or Table H as applicable


                                  Table F

                                 I Name of ownerls of the
                                   land
                                   1!We, the above-mentioned               ownerls of the land, consent to the making of this application.

                                     Signature of ownerls of the             .PI II"" • ~~.                   'fl!cJNlJ€.       n>JJ' f'J€
                                     land                                    UJVV'J'........                 fbwYl.    o'f'     trr~

                                     Date                                        if   /!I!"
                                     Table G

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


                                      Table H

                                      Name of ownerls of the
                                      land
                                        By making this application, 1,the applicant deClare that the OINTlerhas given written consent to the
                                      making of the applJcation.

                                      7.         Identify     if any of the following     apply to the premises          (Tick applicable     box/es.)
                                     ~
                                                Adjacent to a water body. watercourse           or aquifer (e.g. creek. river, lake, canal)-
                                                complete Teble I
                                                On stratesic    port land under the Transport Infrastructure           Act 1994--COmpiete        Table J

                                                In a tidal water area--complete         Table K
                                                On Brisbane core port land under the Transport Infrastructure                  Act 1994 (No table
                                                requires completion.)
                                                On airport land under the Airport Assets (Restructuring               and Disposal) Act 2008 (no
                                                table requires completion)




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