A

A

OWNERS DETAILS - - 111111.111 ,.,..,. .,..... , As the owner(s) of the above property, I / w e consent to this application and to the entry of an authorised

officer of Council to enter the subject property at any reasonable time for the purpose of carrying out an inspection in connection with the assessment of this application. I / w e undertake to take all necessary steps to make access available to the property to enable the inspection to be carried out. Name C x nv.. .D C-1

10.c•C\S

Address: P O nypc 4 4 0 i -roo( €42. IQ ski.) 2 Li ''' 0 Phone No Mobile No: Email:

Signature(s) o f all owners t o give consent to the lodgement o f th is application. ge Cei a f t ' a ( ktol Please Note: This section is to be completed by all property owners. I f the owner is a company, then a director or secretary of the company must sign the application. A statement on company letterhead verifying the signatory's position is to be included in the application. I f the property is within a strata title, the consent of the strata mana .ement is also re. uired. INTEGRATED DEVELOPMENT

Do you require an integrated development approval under the fol lowing Acts? I f you are not sure, please contact Council's Duty Officer f o r clarification on 6566

• Yes E No 3200.

Tick Box if Approval is required

Act Approval Body

. Rural Fires Act 1997 section 100B

NSW Rural Fire Service

• Roads Act 1993 section 138

NSW Roads and Traffic Authority

• Water Management Act 2000 sections 89, 90 & 91

NSW Office of Water

• Protection o f the Environment Operations Act 1997 sections 43(a), 47 and 55; sections 43(b), 48 and 55; sections 43(d), 55 and 122

NSW Department of Environment, Climate Change and Water

MI Heritage Act 1977 section 58

NSW Department of Planning - Heritage

• Fisheries Management Act 1994 section 144; section 201; section 205; section 219

NSW Department of Industry and Investment

• National Parks and Wildlife Act 1974 section 90

NSW Department of Environment, Climate change and Water

• Other

Please Note: (a) Should your project require an Integrated development approval, a cheque payable to the

relevant approval body for an amount of $320 is to be included with your development application. A Council referral fee of $140 also applies.

(b) Nominated Integrated development (approvals under the Heritage Act, Water Management Act 2000) requires advertising in a local newspaper for a minimum period of 30 days. Accordingly, an advertising fee of $1,105 is also required to be paid at lodgement.

_ SECTIO

Do you require an approval under Section 68 o f the Local Government Act? dYes

I f you are not sure, please contact Council's Customer First Centre f o r clarification on 6566 3200.

• No

Tick Box if Approval is required T y p e o f Approval 5Y-Sewer (BF) • Septic (CE) • Other - Please specify

• Solid Fuel Heater (FD) V S t o r m w a t e r (to interlot drainage)

A

A

S E W E RAG

A site plan is required showing the connection point to Council's main. I n c l u d e s c a i n a g e to Council's main disposal system. Indicate whether domestic o r commerci • Domestic • Commercial Plumbers/Drainers Name:

- -LfEence No.

Address:

Suburb: - ..-,

- - Postcode

Phone No: -Mobile Email

L1QUDADEW3TEAPPROV E , _ _. Is the development required to obtain a Liquid Trade Waste Approval?

• Yes • No

O N S I T E WASTE MANAGEMENT SYSTEM (SEPTIC TANK)

I f you require approval under Section 68 o f the Local Government Act f o r a septic tank you are required to supply the fol lowing information and provide plans and specifications. A site plan is required showing location o f tank, trenches and irr igation area andOst-ances f rom boundaries and dwell ings. A min imum distance o f 40 metres to dams ar)q-watercourses, 100 metres to rivers and creeks is required. ------ • Aerated System - • Site Disposal System

Number o f People & No. of bedrooms Brand and Model o f System:

Septic Tank Capacity ----

„..--- Collection W,e.11-- apacity

D i y o s a l area and site area (m2)

WATER WORK

All w a t e r connect ions a r e required form.

SECTION 1 3 8 APPROVALS

Do you require an approval under I f you are not sure, please contact 6566 3200.

t o comple te a separa te W a t e r Service Application

Section 138 o f the Roads Act? • Yes 0 No Council's Customer First Centre f o r clarification on

• Driveways (To be shown on plan) • Stormwater ( to street)

• Alfresco Dining • Hoarding

BUILDER/OWNER

Name s

BUILDER DETAILS ,..---.-----,---- ,-.-1-7,,,,,-,

-tal-

Address

•

A

A

0

0

Suburb

Phone No Mobile No: Email:

LICENCE NO APPOINTMENT OF P R I N C I P A L CERTIFYING AUTHORITY (PCA) Council: (cross appropriate box) C Yes • No Private Accredited Certif ier: (cross appropriate box) • Yes E'No

I f council is appointed as the P.C.A., please complete Kempsey Shire Council's "PCA Agreement Form" and submit t o council t w o days pr ior to commencement o f building works. h t t p 7 / w w w kempsey.nsw.gov.au/bci fsForms/commencement building work.pdf

PRIVACY DETAILS

The information you provide in this application will enable your application to be assessed by us and any relevant state agency. I f the information is not provided, we can refuse the application. Your application will be notified or advertised to the public for comment if the development is designated development, integrated development or advertised development. The application will also be kept in a register by the Council that can be viewed by the public at any time. Please contact the Council if the information in your application is incorrect or changes (Environmental Planning and Assessment Regulation 2000, Clause 56).

REPRESENTING AN ARCHITECT

Only a person whose name is on the NSW Register of Architects (Register) may use the title "architect" or its derivatives to describe the services he or she offers. In the case of a corporation or firm, the Act requires the corporation or firm to notify the Board of the nominated architect or architects who are responsible for the provision of architectural services in order for them to use the title and thereby provide architectural services.

DISCLOSURE STATEMENT OF POLITICAL DONATIONS AND GIFTS A disclosure statement of a reportable political donation or gift must accompany a development application if the reportable donation or gift was made within 2 years of the application being lodged. If the donation or gift is made after the lodgement of the application, a disclosure statement must be sent to Council within 7 days of the donation or gift being made. Further information and disclosure forms are available from Council's Customer First Centre or may be downloaded from Council's website at www.kempsey.nsw.gov.au.

BASIX ( N o t e 5 — P a g e 6)

BASIX Certif icate Details: • Yes — Certif icate Details: Residential development (Certif icate to be attached) _/. only — including alterations D ' No (not required) and addit ions valued at over $50,000

"BASIX Certificate" The Building Sustainability Index (BASIX) is a web-based planning tool designed to assess the potential performance of residential buildings against a range of sustainability indices.

A BASIX Certificate identifies the sustainability features required to be incorporated in the building design. These features may include sustainable design elements such as recycled water, rainwater tanks, AAA- • rated showerheads and taps, native landscaping, heat pump or solar water heaters, gas space heaters, roof eaves/awnings and wall/ceiling insulation.

You need a BASIX Certificate in Kempsey Shire when BASIX applies to the type of development for which you require approval. Commencement dates and details of types of development are at www.basix.nsw.gov.au.

A

A

The applicant is required to submit the BASIX Certificate with the Development Application or Complying Development Certificate application. The plans and specifications must also identify the BASIX commitments which will be checked by a professional building certifier during construction. Where submitted plans or specifications are inconsistent with the relevant BASIX Certificate, Council should require applicants to submit consistent applications before progressing the assessment process, either by amending plans/specifications or by submitting a new BASIX Certificate with commitments that match the rest of the application.

Applicants can generate the BASIX Certificate ONLY ON THE NSW Department of Planning and Infrastructure's BASIX website: www.basix.nsw.gov.au. For more information phone Department of Planning and Infrastructure's BASIX Help Line on 1300 650 908.

SCHEDULE FOR BUILDING compLetelf Construction)

W O R K O N L Y ( or Australian Bureau of Statistics . , . - _ .. ., ... ..., ...... . . , ,.

Information - . Gross floor area of existing

building (m2) What is the current uses of all existing or parts of building(s)/land ( i f vacant, state vacant)

Gross floor area of proposed What are the proposed uses addition or new building of all parts of (m2) building(s)/land? Does this site contain a dual Number of dwellings to be occupancy? demolished Number of pre-existing How many storeys will the dwellings? building consist of? How many dwellings are • ro I osed? MATERIALS T O BE USED Place a tick ( . 9 in the box which best describes the materials that the new , work will be_constructed of: ) ,.. . Frame Code Walls Code Roof Code Floor Code

0 Concrete 20 0 Brick single/double 11 0 Tiles 10 0 Concrete 20 (Concrete/terracotta)

0 Timber 40 0 Brick veneer 12 0 Concrete or slate 20 0 Timber 40

0 Steel 60 0 Concrete/masonry 20 0 Fibrous cement 30 0 Other 80

O Aluminium 70 0 Fibrous cement 30 0 Steel 60 0 Unknown 90

0 Other 80 0 Hardiplank 30 0 Aluminium 70

0 Unknown 90 0 Timber/weatherboard 40 0 Other 80

0 Unknown 90

STATEMENT OF ENVIRONMENTAL EFFECTS .

Schedule 1 o f the Environmental Planning & Assessment Regulation 2000 requires a Statement o f Environmental Effects to be submit ted as part o f a Development Application. Should one not be submit ted, the Development Application may be rejected by Council and returned to the applicant. A Statement o f Environmental Effects should describe the proposed development, address any variat ions the proposed development may be seeking to planning instruments or policies, identi fy any potential adverse environmental impacts and provide an explanation on wha t measures have been taken to minimise these impacts.

Please note: The Statement o f Environmental Effects provided below is only to be used for minor developments, such as new dwell ings, alterations and addit ions etc. More complex development applications will require a detailed Statement o f Environmental Effects which may need t o be prepared by a suitably qualified and practising professional. Should you require clarification on th is matter , please contact Council's Duty Officer on 6566-3200.

1. PROPOSAL DESCRIPTION

Provide a descript ion o f t h e proposed d e v e l o p m e n t

A

A

0

-e'er SE-e- prtioaad by 6416 -

Comments:

2 . P L A N N I N G INFORMATION

W h a t is t h e zoning o f t h e subject l a n d , izeI 1.c. (2--ec-CQc0- or

W h a t is t h e c u r r e n t use o f t h e land /bu i ld ing? S P:›CAS 9 r . u n d $

9 c 0 \ CA& ç C \00

I s y o u r proposal:

• permissible in t h e zone? Yes ta.No 0

• consistent w i t h t h e z o n e objectives? Yes I f {No

0

Does y o u r proposal comply w i t h t h e relevant:

• D e v e l o p m e n t S tandards ( i .e . FSR, he ights) in t h e Local Envi ronmenta l Plan? Yes Gif N o 0

• D e v e l o p m e n t Control Plan (e .g . setbacks, c a r parking)? Yes N o 0

I f you a n s w e r e d " n o " t o a n y o f t h e a b o v e quest ions, a deta i led just i f icat ion is required. Addit ional ly, you should discuss y o u r proposal w i t h t h e D u t y Off icer before lodging y o u r d e v e l o p m e n t application.

A

A

0

3 . S ITE SUITABILITY

Wil l t h e development:

• a f fec t a n y neighbour ing residences by overshadowing o r loss o f privacy? Yes 0 N o

Q7

Yes 0 N o V

• resu l t in t h e loss o r reduct ion o f views?

• i m p a c t on a n y i t e m o f her i tage o r cul tura l significance? Yes 0 N o

El/

• resu l t in land use confl ict o r incompat ib i l i ty w i t h ne ighbour ing premises? Yes 0 N o

12/

• b e o u t o f charac ter w i t h t h e surrounding area? Yes 0 No

• b e visual ly p r o m i n e n t w i t h i n t h e exist ing landscape/streetscape? Yes

V I N o 0

• requ i re excavat ion o r f i l l ing in excess o f 1 met re? Yes 0 N o Ig/

• requ i re t h e erect ion o r display o f a n y advert is ing signage? Yes

/ N o 0

Comments . C\A-VQ1/40e‘eCA

0 . C . c o - k

e V v " \ e

4 . ENVIRONMENTAL IMPACTS

I s t h e s i te a f fected b y a n y o f t h e fo l lowing na tura l hazards? I f yes, p lease indicate w h i c h hazard.

Flooding 0 Bushfire

( N o t e : I n f o r m a t i o n o n n a t u r a l h a z a r d s ava i lab le f r o m Council)

Wil l t h e proposal:

• resul t in a n y f o r m o f a i r pol lut ion ( s m o k e , dust , odour, etc)?

• h a v e t h e potent ia l t o cause a n y f o r m o f w a t e r pollution?

• e m i t noise levels t h a t could a f fect neighbour ing properties?

Yes Q(No

Acid Su l fa te Soils 0

Yes 0 No 53/

Yes 0 No

Yes 0 No

• b e considered potent ia l ly hazardous o r of fensive ( r e f e r SEPP 3 3 for def in i t ions)? Yes 0 No 0

• a f fec t na t ive o r aquat ic habitat?

A

A

rti

• h a v e a n impact on a t h r e a t e n e d species o r habitat?

Yes 0 N o Et/

Yes 0 N o 6:1/

• involve t h e remova l o f a n y t rees? ( I f yes, deta i l t y p e a n d n u m b e r below.) Yes g N o 0

I f t h e a n s w e r is yes, w h a t measures a r e employed t o m i t iga te t h e impact/s?

Comments: 0 Tr' 4?-e- ceo-.N.oNa a 1 clk4 Ok.,) A plicur) (z‘

ct.0,1"..S2 .

5 . ACCESS, TRAFFIC & UTILITIES

A r e electr ic i ty a n d te lecommunicat ions services avai lab le t o t h e site? Yes

ISI/No 0

Does t h e site h a v e access t o t o w n w a t e r ? Yes c l / N o 0

Does t h e s i te have access t o t o w n sewer? Yes I S A °

0

I f y o u a n s w e r e d no t o t h e above , is a w a s t e w a t e r repor t attached? Yes 0 N o 0

Provide deta i ls o f on-site park ing, including n u m b e r o f spaces.

I s lawfu l and practical access avai lab le t o t h e site? Yes l N o 0

Provide detai ls o f proposed m e t h o d o f s t o r m w a t e r disposal (e .g . s t reet , rubble drain, r a i n w a t e r tank)

Comments:

Z F 7:Yr111*IATION T O A C C O M P A N Y A P P L I C K 2 I

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Outbuilding,

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Farm

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All Owners Consent V V V V V V V V VVV / V VVVVV Fees V V V V V V V VVVV V V V V V V V Site plan V V * V V V V V V V V V V V V V V V

Floor plan V V * V V V V V V V ,/ V 4. V V

Elevation plan 4.V* V V V V VVVV V V V *

Section plan 4.V* V V V V VV V V + *

Specifications * V * * 4 * * * * *

Statement of Environmental Effects Specialist Report ,

iiV V V V V V V V VV V V VVV+V

Drainage Plan + V s:a V V V V 4.VVV V V V4..V4.V

Landscaping Plan Pr.?' V * V V • + V 4. V V V • V V V 4. V Notification Plan A4 4. V * V 4. 4. + + V V V 4. + + V

Energy Rating/BASIX + + 4. V + + V V

Erosion/Sediment Control + V * + V V + 4. 4. V V V + V • + +

Water & Sewerage Plan + + * + V + • + V V + 4. 4. ..

Driveway Application 4. 4. + * + * + V V + •

Fire Safety Schedule + V * • + + + + + * *

Bushfire Report 4. V * + + + 4. + + + + +

Flood Statement 4. V * V • + + + 4. + + 4. + +

Flora & Fauna (SEPP 4 4 ) Report

• + + + • • + + • + • a

Shadow Diagrams + 4. * • • + + I i V V 4. +

Onsite Waste System Details

• * 4. 4. + + + + + •

Geotechnical Report • * • + + + + + + 4. +

SEPP 1 Objection + + 4. +

Heritage Report 4. 4. 4. + + • + + + 4. 4. • +

Section 93 or 94 Report + +

Waste Management Plan V V V V V V V VVVV. V V

Liquid Trade Waste 4. + •

Acid Sulfate Soil Report 4. • + + 4. 4. + • + + + +

The table above indicates the m in imum informat ion required t o be supplied f o r you r part icular type of appl cation. Please no te t h a t t h e d e v e l o p m e n t appl icat ion w i l l n o t be accepted w i t h o u t th is minimum information.

Indicates th is informat ion is mandatory. Indicates th is informat ion is required i f you are applying f o r a Construct ion Certif icate o r Complying Development Certificate. Indicates this informat ion may be required.

Certain appl icat ions may require t he submission o f addit ional informat ion t h a t has not been listed above. Council encourages consultat ion pr ior t o lodging you r application. This ensures t h a t many issues may be resolved before an application is lodged and t h a t each application contains all necessary in format ion t o enable p romp t processing by Council.