04/4078 - Change to a Development Approval (Extension to Restaurant) [As Published] · 132004.4078.05

a

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)

[1
Table E Complete if the premises are on Strategic Port Land under the Transport Infrastructure Act 1994
Lot on plan description for strategic part land Port Authority for the lot
[i

Table F Complete if the premises are in tidal water

(1

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)

 

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

 

 

 

 

 

 

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

 

 

 

 

 

 

Total area of premises

 

5,340.00 Xm? (hectares (Tick applicable unit)

 

 

 

 

 

 

‘Existing use of the premises a

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

 

(1 [Surf Lifesaving Club end Public Carpark

 

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

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

 

‘Proposal details “y}

 

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

 

Type 2 Food & beverages (coffee shop 12 seats)

 

 

 

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 applicable) - further information is provided in the advice Section at the end of the form
pp

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 Habitat areas, taking quarry material, taking or interfering with water under the Water Act 2000, etc. )

oO No - Goto Q9 ] 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 not need to answer Q9 - go to the next section.

 

Nature of State-owned resource] 2. Land subject to a lease (including a freeholding lease), or a reserve or deed of grant in trust, under the La

 

Evidence the dept administering the Land Act 1994 is satisfied the development is consistent with an

Table G Nature of evidence required allocation / entitlement

 

 

Allocation/entitlement | Name of authorising Position of authorising] State Govemment Date of | Date of
reference number officer Officer Department _ issue expiry

 

 

1

 

 

 

 

 

 

 

 

‘Owner's consent (if applicable) _- further information is provided in 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.

 

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

|. Date consent |
_ and postal address . (street address of fot on plan description)

was obtained |
——

pepartment oer 61 Hastings Street Noosa Heads Douglas Johp2eiriney, Princip ee g YG
as ddiegate-<f the Minister for Na ural Resou
AND WATER
* Owner's signatura cannot be provided on the form 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, 8127 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 [PA website .

 

Owner's signature*