00154987.001

INTEGRATED PLANNING ACT 1997                                                                                              :           Part A, Version 2.4, 29 May 2006
                   Land owner's consent (if applicable)           20.   Land owner's consent to the making of this application:
                   application must contain, er be supported by, the                                                                    Signature                        Date
                   written consent of tha land ownerss, If the application .
                  (i) S material change of use;                          Ocean                             PAL. wee eee ee ene ew ence ncacunee nce wcnncbeneccecee ee
                   involves:                                               j                                                                                     .
                  (ii) reconfiguration of alot,                            .
                  {fi}, work on tand below high-water mark & not within @ (ti)
                      canal as defined under the Coastal Protection and  wee eee eee re ee eee cee nde e enc eececeee nese nc eee ean eee weedee - oun oe eee
                      Managament Act 1995;or                               7
                  (iv) work on rall corridor land defined under the      (iii)                   :
                     Transport Infrastructure Act 1994.                  a a
                  Sectlon 3.8.1(2)(a) of the IPA provides that             .               ;
                  landowners consent is nof required for a mobile or     (iv)           :
                 temporary ERA.                                          wate n eee n anne e mein rere anew erent en dea nee r rene ne en nen nner rere nee          eon er erences:
                  For more information refer to Guide 1,                  (v)
                  Resource entitlement (if applicable)           21.   Does this application involve a State resource prescribed under a regulation (other than involving
                  Section 3.2,1(5) of the IPA requires evidence of     quarry material on State coastal land under the Coastal Protection and Management Act 1995}?
                  resource entiilement be given for applications that   =                                                                    .                           ;
                  involve a prescribed State resource.                      NO-- go to Q24                          [_] YES - goto Q22                                                         .
                  Saction 3.2.1{10}{a}{ii) of the IPA prescribes that an  .       so,                    .          .          |      .
 :              applicaion aa            to be propery made   | 22.    This application is accompanied by evidence: (tick applicable box)
                  Nan encence ve “a                                    [1 (i)   of the allocation of, or entitlement to, the resource - attach evidence and go to Q23(v)
                  Refer to schedule 10 of the integrated Planning      (_] (ii) the chief executive of the department administering the resource is satisfied the
                  Regulation 1998 that prescribes the nature of evidence    :                   j        j         i                i              i                            _
                  renured by the Slate i cupport of he lodging oft             development is consistent with an allocation of, or entitlement to, the resource - go
   -              development application.                                  7        aa            .                              a        oO                .     :    .          ©
                                                                       (J (iii) the chief executive of the department administering the resource is satisfied the
                                                                                development application may proceed In the absence of an allocation of, or
                                                                                entitlement to, the resource - go to Q23                                                            :
 .                ible ft commeting O23      story ¥evdence |    23.   Evidence of the resource entitlement:                                       :
                 The   Inf         -           z                       .                     .                  ,       ,                 ‘;       :                                       :
                requted under O22   wr Gijatoe                        (i)    Resource entitlement / authority      details               (vil) Official stamp of the department
                 Resources, Mines and Water is mandatory where the     .                                                                     applicable
                 application involves any water or riverine quarry    {ii)  Name of delegated officer
ES               Section 3.2.1(5A) allows the resource manager to Hmlt  ‘
                 comploled ihe ertfunee b ve lrted                 _  (iil) Position of — officer
“5               the time the evidence may be used, Q23 (vi} must be   ii        ifj
  b
 "                                   .                             _  (vy)   - of ~ officer
                                                            -          (v)  Date
                                                                      (vi)  =n date of evidence (if —                                      Be
   ~             Assessmenttriggers                             24.   Is the IDAS Assessment Checklist completed and attached to this application?
                the conviction of oe Oe ote rom enw tt                    YES                ~      [NO -       the assessment manager may refuse to acoept this application on the |
                 Thi      i              if the  applica   i                 -                                  ;                                              ‘e    anniinatire  :
    :            must be completed for all other applications. .                                        .       grounds that the application has not been properly made °,    +     .
                 Plans J drawings / reports                    25.   Plans/drawings/reports accompanying this application:                           .                   eo
                soporte propa endl exes                                     Plan Drawing/ Report Number                |                 Tide =            + | Date]
                An application should be accompanied by detallsto | ~ -                   .                                               '            oe             Sm
                manager, teferral agencies and any person viewing                                    °                    °                   ,                 7
                the application during public scrutiny or public        (i)    719                                         proposed alteration &                   07/05/2007
                Rotification to understand the scope of the proposal                                    ‘                  extension
               and any potential impact.                               wre tee eb ee renee                                                 nnn    ene eee eee anne en eens               .
                                             a                        (i                                                         }                        oe
                                                                        (iti)
                                       ‘                                (iv)                                                                                                               ;
                PLEASE NOTE: The assessment manager may refuss to ecospt an epplication that, at the time of lodgement, fails to provide aff applicable infarmation required by Part A     {
                                    and eny other relevant part of Form 4.                                             :
                             et                                                      i i                                                                                                   |
               OFFICE USE ONLY (epplicable to assessment manager's
          od                                   i       DATE        i                    | RECEIVING OFFICER'S } 2                           | REFERENCE | |    -              5!           fj
                FEE®) = SS                     i    receiven       |  27/6     (a7      _|      NAME/S                  O\     2            :  numBers     | O7/     12-34
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