MCU15/0086 - IDAS Form 1 - Village Bicycle

1-                                                                  Department of Infrastructure, Local Government and Planning



                Listed on either the Contaminated Land Register (CLR) or the Environmental
                Management Register (EMR) under the Environmental Protection Act 1994 (no table
                requires completion)


     Table I

     Name of water body, watercourse or aquifer




     TableJ

     Lot on plan description for strategic port land             Port authority for the lot




     Table K

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




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

                         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
          tC:            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.)


                                           Yes



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




            . es-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
                                                               (dd/mml       number starting with A, B, E, L
                                                               yy)           or P)




     Application details
                                                                                    Version 4.2-3 August 2015