Development Application Vegetation Removal Idas Forms 1 & 6 - OPW120597 · OPW12/0597

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               ODD
    Table C-premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g. channel
    dredging in Moreton Bay)

    Coordinates                                                                                                                                                                          Zone                                     Datum                                         Local government
    (note:place each set of coordinates in a separate row)                                                                                                                               reference                                                                              area (if               applicable)
    Easting                                 Northing                                       Latitude                                    Longitude



                                                                                                                                                                                                                                  D GDA94
                                                                                                                                                                                                                                  D WGS84
                                                                                                                                                                                                                                  D other
                                                                                                                      //

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     D Yes-complete either table D, table E                                                                           or table F as                 applicable



     Table 0


                                                                                                                                                                     ,1 ~~C2.J~
     Name of ownerls of the land
                                                                                                                     if /Yj                 -r y

     (/We,the above-mentioned ownerls of the land, consent to the making of this application.

     Signature of ownerls of the land

                                                                                                                             Plb-                                                                          Vt
     Date
                                                                                                          It) I J)j                         ~./
                                                                                                                                   f




                                     3                                                                                                                                                                                                     Application details-/DAS form 1
                                                                                                                                                                                                                                                  Version 1.0 18 December 2009