DAForm1_AttachmenttoEA.01_signed

                                                                                                   Application form
            Development application Form 1 - Application details—attachment for an
                                         application for an environmental authority

The fields marked with an asterisk * are mandatory, if they are not completed then your application may
be considered not properly made under the Planning Act 2016.

1. Applicant details
To nominate a site or application contact for this application please provide details at Questions 14 and 15.

  Is there more than one              No—provide applicant’s details below.
  applicant? *                        Yes—provide the principal applicant’s details below and all other applicants’
                                      details in Attachment 1—“Joint applicants and appointment of principal applicant”

  Name - individual or contact person if applicant is a organisation*                Suitable Operator Reference
  Cody Johnstonl                                                                     Number*
                                                                                     718 168

  Organisation name, including any trading name (*if an organisation)                ABN/ACN (*if an organisation)
  Noosa Shire Council                                                                97 969 214 121
  Residential or registered business address (not a post office box)*                Phone*
  Level 1, 9 Pelican St, Tewantin QLD                                                (07) 5329 6491
  Postal address (if same as above, write “AS ABOVE”)*                               Facsimile
  PO Box 141, Tewantin QLD 4565
  Email*                                                                                   Indicate if you want to receive
  [email protected]                                                           correspondence via email


1.1 Nomination of an agent for this application
I/we nominate the below agent to act on my/our behalf and to receive correspondence relating to this
application.
  Do you want to nominate an agent for this application?*
     No → Go to Question Error! Reference source not found.
     Yes → Complete the agent’s details here.
  Name of agent – individual or contact person if agent is an organisation
  Lisa McKinnon

  Organisation name, including trading name if an organisation                       ABN/ACN (if an organisation)
  BMT                                                                                54 010 830 421
  Postal address                                                                     Phone
  Level 5, 348 Edward St, Brisbane                                                   3831 6744
  Email                                                                                    Indicate if you do not want to
  [email protected]                                                              receive correspondence via email


2. Details of the ERA(s) that you want to operate
Please list all of the ERAs that will be undertaken on site, including:
     •    Any existing ERAs will continue to operate unchanged on the site (select “Existing” in the table below);
     •    ERAs that are proposed to be undertaken on the site as part of the application (select “New - DA” in the
          table below); and
     •    ERAs that are proposed to be undertaken on this site, that don’t form part of this application as they do
          not require a DA (select “New - EA” in the table below).
Listing all the ERAs that will be undertaken on site will help enable them to all be included on the one EA



Page 3 of 12 • ESR/2015/1791 • Version 8.00 • Last reviewed: 12 AUG 2021          Department of Environment and Science