07/1728 - MCU - Detached House [As Published] · 132007.1728

INTEGRATED PLANNING ACT 1997

j Land owner's consent (if applicabie)

Section 3.2.1(3) of the [PA prescribes that an
‘application must contain, or be supported by, the
‘wiltien consent of the land owners, if the application
Hnvolves:

|) a material change of use;

(8) reconfiguration of a jot;

(i) work on land below high-water mark & not within a
1 Canal as defined under the Coastal Protection and
: int Act 1995;0r

4) work on rail corridor land defined under the

- Transport Infrastructure Act 1994.

Section 3.8.1(2}(a) of the IPA provides that
‘landowner's consent is pot required for a mobile or
temporary ERA

fromore information refer to Guide 1

| 20. Land owner's consent to the making of this application:

Part A, Version 2.4, 29 May 2006

 

\Sjanature

 

 

 

Name
 Qaeeye Seemed
(ii
wo
Wo

 

 

 

 

 

 

 

 

 

 

 

 

; Resource entitlement ( applicable) 21. Does this application involve a State resource prescribed under a regulation (other than involving
j Ceglon 3.2.18) of the IPA requires evidence of quarry materia! on State coastal land under the Coastal Protection and Management Act 1995)?
| valve a pesorbed Slae resouror NO -g0 to. 024 (IYES - goto 22
 pplcaion ae habianiten propery made 22, This application is accompanied by evidence: (tick applicable box)
nwitiout evidence of the neue enttement (J (i) of the allocation of, or entitlement to, the resource — attach evidence and go'to Q23(v)
Refor 1 schedule e10 of the iioreted Planning sence (i) the chief executive of the department administering the resource is satisfied the
i i nature of ev it -
ry eerie RI Sekonehe development is consistent with an allocation of, or entitlement to, the resource ~ go
lopment application, :
: C1 (ii) the chief executive of the department administering the resource is satisfied the e@
’ development application may proceed in the absence of an allocation of, or
. entitlement to, the resource —go to Q23 . :
: Advice for completing Q23 __.___ | 23. Evidence of the resource entitlement:
‘rauedunderQ2s(aerGeboe = | —()-Resource entitlement / authority detail (vii) Official stamp of the department
‘The official stamp of the Department of Natural administering the resource (
, Resources, Mines and Water is mandatory where the a &pplicable)
| application involves any water or riverine quarry (i) Name of “aac Officer
* material under the Water Act 2000.
: Section 32.1068) allows the resource manager eto
| re icrantionce may be used. 25 (w) (iii) Position of — Officer
(iv) = of — Officer
(v) Date
(vi) pen date of evidence =—
! Assessment triggers 24. Is the IDAS Assessment Checklist completed and attached to this application?
; This checklist does ot apply ifthe application requires YES (CI NO = the assessment manager may refuse to accept this application on the
{ the completion ‘And B of the F Ul : ger sg
st be complied tor al ter copes : grounds that the eppiication has not been property made ;
25. Plans/drawings/reports accompanying this application: aa

{plans T drawings / reports
| Am applcabon should be accompanied by detalls to

{ support the proposal & enable the assessment

+ Manager, refetral agencies and any person viewing
* the application during public scrutiny or public
notification to understand the scope of the proposal
Bnd any potential impact.

 

 

 

 

 

 

Plan / Drawing / Report Number Title Date
Nekovne feo GA | Aus ‘on.
Ver NMA. Mo.
fil) wend /stH Bueamion | Mo.

(WheExss AdEse u, ‘

 

 

 

PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide all applicable information required by Part A
and any other relevant part of Form 1.

 

OFFICE USE ONLY (applicable fo assessment manager's}

 

 

 

 

 

“DATE RECEIVING OFFICER'S v REFERENCE
| FeEe B&O | RECEIVED | 2a/efer 2 oe WANES eel prvre—| Sane | 7] [7128
Notification of Engagement of Private Certifier (Optional format’
To, Couneil. | have been engaged as the private certifier for the building work referred to in this application.

 

 

Date ofengagement / /

Accreditation Number.

Name:

Signature: