08/1698 - Preliminary Building Appoval [As Published] · 172008.1698

INTEGRATED PLANNING ACT 1997 Part A. Version 3.1, 3 March 2008

Identify if any of the following agply to the premises by completing Tables D, €, or F. (Ncte: in most instances. the premises will not involve any af the
fcllowing characteristics. however scme applications may involve one or more of ihese characteristics - compiete only if applicable)

Table 0 Complete if the premises are adjacent to or associated with a water body, watercourse or aquifer (e.g. river. creek, lake. canal)

2.

 

 

 

 

 

le E Complete if the premises are on Strategic Port Land under the Transpor tn {nfrastructure Act 1994

Tab
tot oniplan‘description:for strategic port land * VES : Port authority forthelot 2%

   

 

 

 

   

 

Table F Complete if the premises are in tidal water

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

 

 

ais InguselO Of: ithe pramiis

pS a rabbi ance a

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

VACANT UND, HOURE, ONORE2 CONCRAAMONY

5. Are there any existing easements on the premises? (e.g. for vehicular access, electricity, overland flow, water atc.)
No oO Yes - Ensure the type, location and dimensicns of each easement are included in plans, submitted ‘with the apclication

 

 

 

 

 

6. Brief descr iption of the proposal: (e.g. 6 unit apartment building, 30 ot residential subdivision, a bore, avacultue ate.}

 

 

RODTION, OF PERCOLA TO ACPEOKD HOSE.

 

 

7. Does the proposal We building work or operational work (including any services) on the premises?
Yi

Une

@S - Ensure the nature, iecation and dimensicns of the racers works are included in plans, submitted with the application

 
 

  

 

 

   
 

 

     
 

 

 

 

 

 

 

 

 

 

 

 

     

    

 

Res af able eee nie! inortalen forovdecinihe : :
8. Does the application involve taking or interfering with a State resource and therefore r require a resource entitlement? (¢ lec g. the application
involves State iand (leased and freehoid}, declared Fish Habitat areas. taking quarry material, taking or interfering with water under the Water Act 2000, etc.)
iy 0 ~ Ge te C9 oO Yes - Comciete 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 nct need to answer G9 ~ go to the next section.
Table G
rAllocati nlentilement Ss Stale Government : Date of
E “Feferetice number : expiry ®
1.
ea oe RN CO SE Te QE ReaS
EOWheE S Consent (Eapulcenle ater nmmalon enovded mis saves caclen ahasna dren Ses

Complete Table H for applicaticns involving a material change of use; reconfiguration of a fot: work on land below high high-water mark and not

 

9.
within a canal as defined under the Coasta/ Protection and Management Act 1995: or work on rail corridor |and defined under the
Transport Infrastructure Act 1994 . provide details for 2act swner on 2 secarate cow, or on an atachment ic ‘his icrm # sccicabie
Tabled , : ; me is cons
j “Premises Gwner’s namels Details of the ot premises ‘owned . Gwner's signature* Date consent
: . | was cbtained

and postal address (street address or fot on plan description}

 

 

 

 

 

 

 

 

 

‘3 consant must Se orovided ic the assessment manager on an
27 af the Corperations Acc 2001 (C-weaith) details how a

 

* Owner's signature cannot Se provided an the form if you intend io submit the acclication stectronically. Owner

attachment containing accreoriate written documentation of the owner's consent. If ihe owner's a comean

company May sign as owner. Tamelates for the crovision of owner's consent are available on the Jf
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