f­

w

w

o;'.

I­

C/)

l­

o;'.

::)

I­

C/)

I

I

I

I

b..

I

I

I

I I

2940

I I

I I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

TV

b_ ___ _

'i

@ �.9.�OSED FLOOR PLAN

2400

5120

TV

3375

,-- -----

I

I

I

I

I

I

I

I

I

I

----, I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

STORE

� -----'--NEVI DISPIAY WINDOWS TO EXISTING OPENINGS

GLAZE D DOOR TO STAY IN CLOSED POSITION

m "'

___ [l ]l ___ _ 3700 3700

'i 'i

4940 3045

2745 1130

jJ ____ _

3700

'i

6680

2215

STORE

3700

....J

I

I

I

I

I

I

I

I

I

I

I

I

I

.d

'i

(9 �TERIOR VIEW PROPOSED

e)�CTIONBB

JUOORM-01\Yfu�.aj Dra-f'f<t9sVM'l-01.rrl

Pt 2.Y&fil.23 PREl.MfAAY 15SLE

2lOY2020 3 37 .16 PM

=-�·F A R C H I T E C T S

RAY WHITE· HOWLONG

MINOR ALTERATIONS, 41 HAWKINS STREET

PROPOSED FLOOR PLAN A103 P1

PRELIMINARY S!Zeshw.11 bA1

A

g g

0

I /2/

:fc

ii /1

; I

I

I

I

I I I I h._ _______

I I

I

�!.'1

I I I I I I I I I I I I

7

I I I I I I

.J

5120 3375

WH

r-------------

I I I I I

I I I I I I -----------------I

DISPLAY \VJNDDW

I I I

�---------7

I\ I I \ I

I I 'b I I \ -9- I I '1b. I I ' I I \ I I \ I I I I ' I I \ I I L---------�

I I I I I I I I I I I I I

------------'j'-_j

I �---------�---------�------------•-----

2940 4940 3045

C) �.1�rlNG FLOOR PLAN

2745 1130 2215

_ _IL _______ _

6680

I I I I I I I I I I I I I

JI

U �TERIOR VIEW

C)�CTION AA

P1 �.03.02 PRatl.U·AAY 1-SSLE

m:v203>-43500PM

_--1� I I

A R C HIT E C T S

RAY WHITE - HOWLONG MINOR ALTERATIONS, 41 HAWKINS STREET

Drar,71gt-J:,

EXISTING CONDITIONS A102 P1

PRELIMINARY Sra'es-hown

;,Ai

C I

5'

�---�--NEWDISPIAYWINDOWS T O EXJSTJIIG OPENIUGS

200x!OORHS-----------

BEAM---

-

----

100x50RHS RAFTER

I - ----------------------------------------------

100SHS COL.

LDEMOLISH EXJSTING VERANDAH TENANCY 2

_ __yO G-our.dFloor

NEW STEEL FRM'ED VERANDAH

�Ml OCOR HfAO I-EK31-ff

J.lWRi'1HOJ\Worlurg Orat.irgMM-01.r.1

Re,'eCtl Re.is3oo0ae Rwl.sicnDe�foi

P1 2);(1,0323 PRElP.1/AAY ISSLE

2lOl@:aJ3.J7:23 PM

� w��ir A R C HIT E C T S

RAY WHITE - HOWLONG

MINOR ALTERATIONS, 41 HAWKINS STREET

PROPOSED ELEVATION & SECTION

A104 P1

PRELIMINARY

� --�

FEDERATION COUNCIL

0 100 Edward S\reel Corowa NSW 2646 <SI PO Box 77, Corowa NSW 2646 el (02) 6033 8999

© council@federalioncouncil.nsw.gov.au

STATEMENT OF ENVIRONMENTAL EFFECTS

Standard form for minor developments only.

A COMPLETED STATEMENT OF ENVIRONMENTAL EFFECTS (SEE) IS REQUIRED TO ACCOMPANY ALL DEVELOPMENT APPLICATIONS EXCEPT INTERGRATED

DEVELOPMENTS WHICH REQUIRE AN ENVIRONMENTAL IMPACT STATEMENT (EIS).

ABOUT THIS FORM: This SEE template is designed to form an attachment to the Development Application. It can only be used for the following development types:

✓Dwellings, single storey in the Rl, R2, RUl, RUS and RS zones.✓single shops or commerda\ premises in the B1, 82 & B6 zones*✓Residential alterations and additions✓ Ancillary residential buildings and structures such as, verandahs, carports, garages, sheds, pergolas, swimming pools,

* Please note that a heritage Impact statement Is required for all premises within the Heritage Conservation area. This will be required forthe majority of developments In the commercial precinct of Corowa.

Developments not listed above may require a SEE with greater detail. Please contact Council for further Information.

The SEE must address all Impacts that are relevant to your proposal, with comment on how the development will control or mitigate the impact. No matter how minor the impact, please advise Council In this document.

Failure to provide the requested Items will delay processing of the development application and may result In the application being returned to you for completion or you receiving an additional Information request from Council.

Property Name;

Unit/House No.: t.// Street Name:

Town: /Jo i✓t.- 0/1/l., Postcode: ''2.-61/ 3Lot:

B Section: DP/SP: /5 7 2,pO

PROPOSED DEVELOPMENT

Where applicable include a description of matters such as proposed buildings, proposed building materials, nominated colour scheme. Nature of use, staging of the development, details of any demolition and other works to be carried out in site.

) f2c.1/Y/ove c/4rY?ct·11J e:x1�flv1 (/tv1Jt1c/ub1 re: !t.t(e L/1 t /-7.fv c!t':J/c,r1 /4 t:t /(()1..; 1,rwvt. )'-i,, ,;,,Jv 'U! �z 1 �t-t/, 111 )I J;J-'7 " o/Vt1�

Is your proposal permissible in the zone under Corowa LEP 2012 / Urana LEP 2011 is your proposal consistent with the zone objectives? Is your proposal in accordance with Corowa DCP 2013 / Urana DCP 2011 NO

NOTE: If you answered no to any of the above questions please discuss your application with Council staff.

Are there any other planning controls relevant to your proposal If yes, please list controls and how the application complies:

□ YES rs/ NO

DESCRIPTION OF SITE

Include where applicable a description of the physical features of the site such as shape, slope, vegetation, waterways. Fie,/ W//Yl.o-,- 8/oc·d. Ir, /--/4,u(o,-t,,J 68'0.

7

What is the present use and previous use(s) of the site? f2c-.s I cl-Rn /2t(I / /we,€, e $ 6'/w;0 /;vt? /-,

Is the development site subject to any of the following natural hazards?

Bushfire Prone □ YES �� NO Flooding □ YES �/ NOStorm water inundation D YES b2f NO

NOTE: If the site is identified as Bushfire Prone it will be necessary to address the Planning for Bushfire Protection Guidelines. For further information please consult the NSW Rural Fire Service website www.rfs.nsw.gov.au

How will you mitigate the Impact of the natural hazards for this development? /VIL � f../.e a,,-e r.vf Ch.t11-'f,l;,,'I c;n,;,/J,,,,,,1 �,, / v, 'II ud./ r-1!5/c /v

Is the site constrained by any of the Terrestrial biodiversity following? (Please refer to LEP Maps) Riparian Land and Watercourses

Groundwater vulnerability Wetlands Item of Environmental Heritage or in conservation area "'

How will you mitigate the impact of the development on these constraints?

L

*Note a Heritage Impact statement may be required. Please discuss with Council

What types of land use and development exist on the surrounding land? B 2 ,_ i.,:Jc '-i I u .. ,y4,�

Inconsistent with the existing streetscape? Out of Character with the surrounding area? Inconsistent with surrounding land uses? Vary a building line setback If you answered yes to any of the above please provide details and justification for the proposal?

r r

r

r

r

YES YES YES YES

YES J3/NO YES �NOYES YES ��

YES r/No

Ci'!l'/1111-/G Ol'l'OH I UNlfY , .1 , 1 :.• ,:,\' ,, !•, , , •: 1;_'.I IHI I Y

PRIVACY, VIEWS AND OVERSHADOWING

Will the development result in any privacy Issues between adjoining properties as a result of the

placement of windows, decks, pergolas, private open space etc?

Will the development result in the overshadowing of adjoining properties resulting In an adverse

impact on solar access?

Will the development result in any acoustic issues between adjoining properties as a result of the

placement of active use outdoor areas, vehicular movement areas, air conditioners, pump, bedroom

and living room windows etc?

Will the development impact on views enjoyed from adjoining or nearby properties and public places

such as parks, road or footpaths?

If yes, please provide details of issue. Some issues will require plans, i.e. overshadowing.

Is legal and practical access available to the development?

Will the development increase traffic movements/volumes?

If Yes by how much and what types of

Vehicles?

Are additional access points to a road network required?

Has vehicle maneuvering and onsite parking been addressed in the design?

Is power, water, electricity, sewer and telecommunication service readily available to the site?

Comments

ls the development likely to result In any form of air pollution (smoke, dust odours etc?)

Does the development have the potential to result in any form of water pollution (I.e. sediment from

runoff)?

Will the development have any noise impacts above background noise levels? (i.e. air conditioner

units, pool pumps)?

Does the development Involve any significant excavation or filling?

Could the development cause erosion or sediment runoff (including during construction)?

Is there a likelihood of the development resulting in site contamination?

ls the development considered to be environmentally sustainable (including provisions of BASIX

certificate where required)?

Is the development situated in a heritage conservation area or likely to have an impact on any

heritage item or Item of cultural significance?

ls the development likely to disturb any aboriginal artifacts or relics?

Comments

r YES r/ NO

r YES �NO

r YES �NO

r YES �NO

YES

j? r YES NO fv' YES r NO

YES r NO

r YES

r YES �NO

r YES V NO r YES fv' NO ,- YES �NO

rv/ YES r NO

r YES p/ NO

r YES i/No

C111'J\I IHG Ol'l'OH I UNITY' 1 1 • I • :;, i •I 1:,, ', •;:.1,r.111 Y

N&!•iit,tM111®iii*t;d¢•1,lil•O®ii@IA•J.iQ@Otf.JQM#rt-itf◄�iiiW.:Xi.18ihkffih4\i4•t1.f44!4iitW!4•!ffe•Is the development likely to result In any form of air pollution (smoke, dust odours etc?) J . YES P NO

Will the development result in the removal of any native vegetation from the site? r YES p/ NO

Is the development likely to have any impact on threatened species or native habitat? j YES re/ NOIf the answer is yes to either of the above questions it may be necessary to have a formal seven part test completed to assessthe Impact on threatened species - please contact Council for further information. Comments

Will liquid trade waste be discharged to Council's sewer? � YESWill the Development result in any hazardous waste or other waste disposal issue? r YESHd_ow wil

d! st

fo

7rmwater (from roof and hard standing areas) be rv/council System r other (Provide Details)1spose o

Details: 1� yt.Jl}f q,yeC( L/; II r1u/ c/2«,, -t' ,Sp /:tiwe 1,..,1,// 6-e ;u, /ey/-n,,, 'Shll'tnvl,tk,(y I

Have all potential overland stormwater risks been considered In the design of the development? YES r NO

Comments � .,. <. t/1/1 I/ Jr! /1,r,J ,(hau-y (" /27 .:5;/2,.,.-",.,, �,t:,, k..--. I

WIii the proposal have any economic or social consequences In the area? r NOHas the development addressed safety, security or crime prevention issues? YES r NO

Comments 1/,y: f}t"'Of't'(54/ v,'// At'(v� 11'/t't'fl e/(J_OY)()I/VJ1(. 6e,ul,/

/J-'1-t' fi>t-vh (A§ / / (,/1 // q//(li..; V C,j/ft7/t't!.,,- -sl-ner// -6t,( _ _(l.,,u ·sh()t,v'f.. 1--V}C-/10 /"t.7,:'{&( olrul /yr,,r1/q 'C ;/2:, :5h.flt.,; C.'t:.S(" _,.,,,..

1hc_ ./owv-, Cbt1r;/(',1JI( hw.J /10 l/trct>;-?/ //>'f?',07 1"0ttt,✓ sk /41-1/s ,OTHER RELEVANT MATTERS

Are there any other matters for consideration that you are aware of as developer?(I/IL

/4 lo

Cllf.AIINO OPPOH I UNITY• 1 · '-' :.-1 ,, J,, , , :: "·.'! IHI I Y

OTHER RELEVANT MATTERS (Continued) . ·

LEGAL REFERENCES Section 78A(9) of the Environmental Planning and Assessment Act 1979 states that the regulations may specify what is required to be submitted with a development application.

Section 50(1)(a) of the Environmental Planning and Assessment Regulation 2000 states that development applications must contain Information and documents specified in schedule 1 part 1.

Schedule 1, part 1, subclause 2(1)(c) of the Environmental Planning and Assessment Regulation 2000 requires the submission of Statements ofEnvironmental Effects (SEEs) with all development applications ( other than complying and designed development),

Schedule 1, part 1, subclause 4 of the Environmental Planning and Assessment Regulation 2000 states that such SEEs must show: • The environmental impacts of the development• How the impacts have been identified?• The steps to be taken to protect the environment or lessen the expected harm to the Environment• Any matters req ulred to be indicated by any guidelines issued by the Director-General.

The Applicant is advised that Council will make copies of (including electronic copies) of the development application and accompanying documents for the purpose of complying with its obligations under the Environmental Planning and Assessment Act 1979 and the Local Government Act 1993. The applicant is responsible for obtaining all copyright licenses necessary from the copyright owners for this purpose,

PRIVACY STATEMENT: Information provided to Council may comprise personal information as defined under the Privacy and Personal Information Protection Act 1998, Personal information may be utilised by Council to assess any application under the Environmental Planning and Assessment Act 1979 and in accordance with other legislation. Please note that personal information may also be made available to third parties i.n accordance with the Government Information (Public Access) Act 2009,

COPYRIGHT STATEMENT:

1. To the extent that the signatory to this form is the copyright owner of documents lodged with this application, you licenceCouncil to make all documents publicly available, and further licence Council to reproduce and/or communicate all suchdocuments for any purpose associated with the exercise of Its functions, and for the purpose of complying with its obligationsunder the Government Information (Public Access) Act 2009 and any other applicable legislation.

2. By executing this form, the signatory warrants that to the extent that he/she is not the copyright owner of any documentslodged with this application, Council Is licensed by the copyl'ight owner to use the documents lodged with this application inaccordance with paragraph 1 above.

3. By executing this form, the signatory indemnifies Council against all claims and actions in respect of a breach of copyrightarising from any unauthorised use of any documents lodged with this application.

Clll:1\111-Ki Ol'l'OFI I UNITY , .I l;; '.·,'·•I•, , ':: ··:111-!1 I 'I

�-­�

FEDERATION COUNCIL

APPLICATION FORM

0 100 Edward Street Corowa NSW 2646

8 PO Box 7 7, Corowa NSW 2646

� (02) 6033 8999

® council@federationcouncll.nsw.gov. au

DEVELOPMENT APPLICATION/ CONSTRUCTION CERTIFICATE /COMPLYING DEVELOPMENT/ PLUMBING Environmental Planning and Assessment Act 1979 and Local Government Act 1993

• Council w/11 not accept incomplete applications. It Is the respons/bl/lty of the applicant to ensure the required Information is provided.• Associated fees must be paid at the time of lodgment,

PRIVACY STATEMENT: Information provided to Council may comprise personal Information as defined under the Privacy and Personal Information Protection Act 1998, Personal information may be utilised by the Councll to assess any application under the Environmental Planning and Assessment Act 1979 and in accordance with other legislatlon. Please note that personal Information may also be made available to third parties In accordance with the Government Information (Public Access) Act 2009.

Development Application (DA) is/construction Certificate (CC) D Complying Development Certificate (CDC) ii Plumbing Application (LGA) D Manufactured Home (Section 68)

Have you attended a Pre DA Meeting with a Council Officer: □ NoWYes-lfYes, With Whom: jfaf?�

{If you are /nsta/1/ng a new septic system please complete the Application to Install, Construct, Alter or Operate an On-Site Management System form) PROPOSED DEVELOPMENT

Please provide a detailed description of your proposal- lncludin� details of �he subdivision, the use of any buildings, demolitions or tree removals.

/?eJ(J/qee., c..t-fvr7:?.wf Ve-rc:tl'?dcth v,-/IJ ne..v c/e6i9h.. 4dc/ c, c//sohletl J,:nld-_j I<. ''/ c.,4.e.. n�c., . LlA � i. V C/ Cl 11 t/4 /2 t,.-,, '/ / b<?.. YC--;,11,{)v,ecf. !Ve (..I 1/e f" Qf? r/4,t, 1.1."I/ b� b!,f/; f vi /-4 ti s�/ G:t:<� _

APPLICANT DETAILS:

Name:

---------------------�ABN: _________________ _ Postal Address: /7 0 (J� 3

Company:

Town: I.Jo vLo/1/C, State: fr.51../ Phone no.: _________ _ Mobile: Of/JJ-2-rf?''!?....

Post Code: 2A5' V 5Email: q.,,/4..uy . /2.:tr.fslt""'"' @(o/�h•I-" · C//17

APPLICANT'S DECLARATION: I/We the applicant declare to the best of my/our knowledge and belief that al/ the particulars heron Is correct in every detail and the

information required has been supplied. I/We also hereby consent to Council displaying and copying the application and supporting documentation including

designs, for the purpose of seeking JJ!!;lic '}'�� w�. '>/' J t;>U / 'VJ -z_.,i) Applfcant Signature: �� Date: ___ c__..._..,/'--l_7-r-/_ 4 _____ _� I I

Documentation Dellverv �ail □Post □Hold For Connection

PROPERTY DETAILS

Property Name: _________________________________ �-------Unit/House No.: __ �9,_/ ______ Street Name: /f /J-U /< I .,1/S · S T/t. £ET

Town: Ito wt.t,,v4 State: /J/6V Postcode: V'I J Lot: B Section:______ DP/SP: !'57-ZooArea Of Land: _____ ha

Date Documentation Received: ___________ _ Total Fees:$ _____________ _

Receipt Number: ____________ _ Date Paid: ______________ _

Application Number: __ I _0_._2_0_').._Q_._8_O----'-...... I ________ _

(Cf CREATING OPPOllTUNITY, I 11 I li 1,\l li•li, ':n:,tH\Ji·II I Y

D Integrated D Staged

Proposed Development:

D Residential - Alterations & Additions D Dual Occupancy/ Multi-Unit D 9emolitlon D Residential - Minor Structures

□ Designated

□ Residential - Single DwellingD Swimming Pool

l:it'commerclal /Retail/ Office □ Industrial D Subdivision □ Subdividing a building into strata units'

□ Changing the use of land or a building, or theclassification of a building?

. 0 Other: ______________

Is the proposed development located on contaminated land? □ Yes �o _______________

Does the land contain and culturally significant or heritage items? □ Yes efNo ______________ _

Current Use of Land: __ _.,[J=--2-�_-__ Lo_�C'-C/"'--/ __ C_t:-_·""1!_�_=----------

NOTE: If you do not apply for demolition on this application, and you need to demolish structures on the site, a separate Development Application will need to be submitted to, and approved by Council prior to the removal of any structures from the property.

TYPE OF CONSENT:

DYES - Please attach an Environmental Impact Statement (EIS) Is your proposal a Designated Development? DALL Other Developments - Please attach a Statement of EnvironmentalEffects (SEE)

Is your development an Integrated Development?

(If your application requires one or more approvals from state agencies then your development Is Integrated.)

0 YES

NOTE: An amount of $320may be app/Jcable for some state agency that will assess your proposal must be paid to Council upon lodgment together with an additional copy of your application and relevant documentation for each agency,

STAGED DEVELOPMENT

You can apply for development consent for part of your proposal now and the remaining part(s) at a later stage.

ifNo Are you applying for development consent in stages? 0 YES

If Yes, please attach: information which describes the stages of your development; Copy of any consents you already have for part of your development.

CONSTRUCTION STATISTICS

This information ls required by the Australian Bureau of Statistics (ABS), The ABS uses this information as key economic indicators for the

country. If there are two or more different material types to be used, then please nominate the primary material type.

Is proposed building a: D New building �teratlons to existing D Additions to existing

Value of development lncluding GST: �$�3�0�,_0_CJ�O�· _____ Total floor area of development: S 4 · 3 m2

Description of existing developments on land: __ /_x __ 3 __ b_o:Jz_-_�_'l""? __ /2_�_;s_c:.,..._�_3 _ _;;_/X __ U/--'' _Y"�;?i._�_a_s.c;_. __ _

21/3/19 Version 2 -19/8532

oh¥ ;;�VII. I

�·

�

-�

FEDERATION COUNCIL

CONSTRUCTION STATISTICS

FLOOR FRAME WALLS ROOF

ief concrete or Slate Gl'Timber D Brick Veneer □ Curtain Glass □ Tiles

□ Timber �tee! rr1'Full Brick D Steel dsteel/Colourbond

□ Other □ Aluminum �oncrete or Stone □ Aluminum □ Other

□ Not Applicable D Other Fiber Cement l!1 Other □ Not ApplicableD Not Applicable i;;l,-1mber D Not Applicable

No. of existing dwellings on land which the new building is to be erected:

No. of dwellings to be demolished In connection to the new bullding:

No. of Storeys:-----'----- No. Of Residential Units: __________ _

BUILDERS DETAILS

Name:

Licence Number: / <t '-f 7 YltC □ Owner Builder

Address: -�1/_C __ ·�· �������/2(2�c,�c��..,,__,_Vt._'?J_af?_-✓._..,q,._q __ v,�/_C_�5'_<5�'f_O ______//1:..,,..q1..,,,-, Cu� Email:

Mobile No.: _______________ _

PLUMBERS DETAILS

Name: la SJ 1 '.d7 P luml>,iJ Licence Number: Zd't .'?]C/ C. D No Plumbing works being undertaken

Address: -----�----,-------.---------------------------

Email: l o 5.S 1 ·c�'i/2 lwm6ty e 6 /J/2/)"'c/. U)M-7

Phone No.:_________ Mobile No.: Di/ (JO i.t'OJ ;)16g

•

•

•

•

•

•

•

Is the removal or clearing of native vegetation proposed as part of this application:

If yes, what Is the area of vegetation proposed to be removed or cleared? m2/ha: _________ _

Is the land or part of the land identified as critical habitat? D Yes t:i'No D Unsure - Go to https://www.envlronment.nsw.gov.au/

Is the development likely ;9 significantly affect threatened species, populations or ecological communities

their habitats? D Yes GfNo D Unsure

Is the development biodiversity compliant development? D Yes �o

If yes, the reason why the development is biodiversity compliant development:

Is this application accompanied by a biodiversity development assessment report? D Yes B"No

Is the land subject to a private land conservation agreement? D Yes ttNo

If yes, provide a description of the kind of agreement and the area to which it applies:

or

Development consent will be required from Council for the rlngbarklng, cutting down, topping, lopping, pruning, removal, Injuring or wlllfully destroying of vegetation and tree(s) that ls not ancillary to the consented use of the land nor Is part of a development application for a development permitted with the consent of Council In the zone that applles to the land. An application for tree removal Is not a guarantee that removal wlll be approved. Generally, consent will not be given to remove trees that are assessed as healthy and structurally sound by the Council tree assessment officer.

21/3/19 Version 2 -19/8532 � -�

FEDERATION COUNCIL

REQUIRED DOCUMENTATION

Please provide Two (21 copies of all documentation excluding application form unless indicated below. Plans are to be provided in A3 size (drawn to scale). All plans must show North Point. Larger

plans may be requested.

DeveloQment Ai:rnlications Construction Certificate ComQl�ing DeveloQment Plumbing At:1t:1lication

�Locality Plan �ocality Plan D Locality Plan 0"s1te plan

E1's1te Plan Gefsite Plan D Site Plan □ BASIX or BCA Section JReport

D Elevations D Elevations D Elevationst{here a�r,J/cab/e)

Floor an (existing andproposed works are shown separately)

□ BASIX or BCA Section J □ BASIX or BCA Section J □ BASIX or BCA Section J □ Hydraulic designReport Report Report (larger commercial projects) (where applicable) (where app/icab/e) (where applicable)Floor Plan (existing and

□ Floor Pian (existing and D Floor Plan (ex/sting andproposed works shown separately) proposed works shown proposed works shown

�aternent ofseparately) separately) Sectional plans Sectional plans (indicating

Environmental (indicating detailed deta//ed Effects (2 copies) construction) construction)

D Specifications D SpecificationsD Structural or Civil

D Structural or CivilEngineers design Engineers design

COPYRIGHT STATEMENT: 1. To the extent that the signatory to this form Is the copyright owner of documents lodged with this application, you licence Council to mal<e all

documents publicly avaliable, and further licence Council to reproduce and/or communicate all such documents for any purpose associated with the exercise of Its functions, and for the purpose of complying with its obligations under the Government Information (Public Access) Act 2009 and anyother applicable leglslatlon.

2, By executing this form, the signatory warrants that to the extent that he/she is not the copyright owner of any documents lodged with this application,Council ls licensed by the copyright owner to use the documents lodged with this application In accordance with paragraph 1 above.

3, By executing this form, the signatory indemnifies Council against all claims and actions in respect of a breach of copyright arising from any unauthorised use of any documents lodged with this application.

OWNER'S DETAILS

Postal Address:

Phone No.:, ____________ Moblle:

/P',S V Postcode: 'Z:-6� J

I/We the owner(s) of the property described in this application, consent to its lodgment and hereby permit any duly authorised officer of

Federation Council to enter the land or premises to carry out inspections as required for the administration of the Act(s), Regulations or

Planning Instrument.

Name (Print): l(/lf)fa /Vf /J#IZ!f/ll�y (Owner/Director): (}t.1/VE./),I

Name (Print): ___________ Capacity (Owner/Dlrector): ______ Slgnature ________ Date:

All owners of the /and to be developed must complete this section. If the land Is owned by Crawn Land, an authorized officer of tile relevant department must sign the application, If you have recently purchased the land, you must provide a Certificate of Title or Transfer Certificate showing transferor, transferee and the current Lot and DP number of the property. If the land Is owned by a private company (P/L), the signature of at least one (1) director residing In Australia is required. In the case of a pub/le company, the signatures of three {3) directors are required, two (2) of which must res/de in Australia.

�·

21/3/19 Version 2 -19/8532 � ---...:.::::.:-

FEDERATION COUNCIL