Colac Otway SHIRE

Planning Enquiries Phone: (03) 5232 9400 Email: inqacolacotway.vic.ciov.au Web: www.colacotway.vic.gov.au

Clear Form

Application Type Is this a VicSmart application?'

Office Use Only

VicSmart?

Specify class of VicSmart application:

f l YES r i NO

Application No.: Date Lodged:

Application for a Planning Permit If you need help to complete this form, read MORE INFORMATION at the back of this form.

.1116. Any material submitted with this application, including plans and personal information, will be made available for public viewing, including electronically, and copies may be made for interested parties for the purpose o f enabling consideration and review as part of a planning process under the Planning and Environment Ac t 1987. If you have any concerns, please contact Council's planning department.

A Quest ions marked w i th an aster isk (") mus t be completed. A L If t he space provided o n the fo rm is insuff icient, attach a separate sheet.

Click for further information.

No 0 Yes If yes, please specify which VicSmart class o r classes.

A If the application falls into one o f the classes listed under Clause 92 or the schedule to Clause 94, it is a VicSmart application.

Pre-application Meeting Has there been a pre-application meeting with a Council planning officer?

0 No e(Yes

If 'Yes', with whom?:

Date: 7 day / month / year

The Land ill Address of the land. Complete the Street Address and one of the Fomnal Land Descriptions.

Street Address - Unit No.: St. No.: St. Name: 1%./1 t a i SrRe.E1c

Suburb/Locality: BA Postcode: 32_5-k

Formal Land Description Complete either A or B. A

A This information can be found on OR the certificate o f title

If this application relates to more than one B address, attach a separate sheet setting out any additional property details.

Lot No.: ":"")Lodged Plan C Title Plan (7) Plan of Subdivision

Crown Allotment No.:

No.:

Section No.:

Parish/Township Name: A.SP•C_

Application for a Planning Permit I Combined Page 1

D20/216083

The Proposal A You must give full details o f your proposal and attach the information required to assess the application.

Insufficient or unclear information will delay your application

1 1 For what use, development or other matter do you require a permit?

I I I Estimated cost of any development for which the permit is required

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r a Provide additional information about the proposal, including: plans and elevations; any information required by the planning scheme, requested by Council or outlined in a Council planning permit checklist; and if required, a description

o f the likely effect of the proposal.

cost$ You may be required to verify this estimate. Insert '0' if no development is proposed. If the application is for land within metropol i tan Melbourne (as defined in section 3 o f the Planning and Environment Act 1987) and the estimated cost of the development exceeds $1 million (adjusted annually by CPI) the Metropolitan Planning Levy must be paid to the State Revenue Office and a current levy certific e m u s t be submitted with the application Visit wwwsro.vic gov au for information.

Existing Conditions U Describe how the land is used and developed now For e x a m p l e , v a c a n t , three dwe l l i ngs , m e d i c a l c e n t r e w i t h two prac t i t ioners , l i censed restaurant w i t h 8 0 sea ts , grazing.

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0 Provide a plan o f the existing conditions. Photos are also helpful.

Title Information U Does the proposal breach, in any way, an encumbrance on title such as a restrictrive covenant, section 173 agreement or other obligation such as an easement or building envelope?

Encumbrances on title 0 - Y e s (If 'yes' contact Council for advice on how to proceed before continuing with this

goplication.) 0 Not applicable (no such encumbrance applies). la Provide a full, current copy of the title for each individual parcel o f land forming the subject site.

The title includes: the covering 'register search statement', the title diagram and the associated title documents, known

as 'instruments', for example, restrictive covenants.

Application for a Planning Permit I Combined Page 2

D20/216083

Applicant and Owner Details Provide detai ls o f the applicant and the owner o f the land

Applicant tam.:

T h e person who wan ts the pe rm i t Title. t,..A r- )F i r s t Name, 'Vet t-t, Surname: INA

Organisation (if applicable):

Postal Address

Unit No.: St No : Qi a PO Box, enter the details here

St. Name. rtrA

Suburb/Locality: 1?) State: V I c_ IPostcode. ,„.5 Please provide at least one contact Contact Information for applicant OR c phone number

Where the preferred contact person for the application is different from the applicant, provide the details of that person,

Owner

The person o r organisation who owns the land

tilihere the owner is different from the applicant, provide the details o f that person o r organisation.

Business phone: ceii,3

son below

Mobile phone:

Email: fkieor.,E4,2,s

Fax:

Contact person's details* Nomo

First Name:

Satr..a as applicant

Surname:

Organisation applicable):

Address

Unit No.: S t No

ri is a s P.O. EQX, enter the details

St. Name:

Suburb/Locality: State: t

I Postcode:

Name.

Title: First Name: N.

Same a

Surname:

Organisation (if applicable):

Postal Addzers

Unit No

Suburb/Locality:

St. No.:

if it is a P.O Box, enter thiS details here:

S t Name:

State:

Ovmer's Signature (Optional):

Postoode:

Date

day I mont year

Information requirements Is t h e required information provided?

Contact Council 's planning department to d isa iss the specific requirements for his application and obtain a planning permit checklist

C iNfes 0 No

Declaration MI T h i s f o r m m u s t b e s i g n e d b y t h e applicant*

A Remember it is against the law I declare that a m the applicant, and that all the information in this applioation is to provide false or misleading (orrect ; and the owner (if not myself) has been notified o f the permit application Information, which could result in a heavy Ana and cancellatio Signature: , of the permit:

and

Date: ).--ct

day / month / year

Application tor a Planning Permit I Combined

D20/216083

Checklist 131 Have you:

[ j / F i l l e d in the form completely?

Paid or included the application fee? Most applications require a fee to be paid. Contact Council

i s , to determine the appropriate fee.

F l Provided all necessary supporting information and documents?

full, current copy of title information for each individual parcel of land forming the subject site.

RrA plan of existing conditions. Fq.Plans showing the layout and details of the proposal. Rt.-Any information required by the planning scheme, requested by council or outlined in a council planning permit checklist. 12