IDAS form 1 · OPW12/0427

Tabte C-premises coordinates (appropriate for devetopment 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 ofcoordinates in a separate row)                   reference                            area (if appticabte)

Easting         Northing           Latitude          Longitude



                                                                                      I     GDA94

                                                                                      T     WGSs+

                                                                                      n     other




5. Total area of the premises on which the development is proposed
                                                                            (indicate hectares or m')


               L,e .{:{r nt -. -1,/.--r- g,^,*-. tt U &*J * Mf;&d} {€-- "'2,,'
6. Current use/s of the premises (e.g. vacant land, house, apartment building, cane farm, etc.)



   iL<z
7. Provide a brief description of the proposal (e.g. six unit apartment buitding, 30 lot residential subdivision etc.)




8. ls owner's consent required for this apptication? (refer to notes at the end of this form for more information)


V      No


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



Table D

Name of owner/s of the land                   Nt,; L.j*, t,f,-,w*
l/We, the above-mentioned owner/s of the land, consent to the making of this application.

Signature of owner/s of the land



Date                                          irltuf tL

                                                                                             .:;;il,;: !j111 't'",':.:i,'--IDAS f1fm I
                                                                                             Version t,o t8 Decentber 2oag