Application for a pre-design/pre

Form
Corporate
Application for a pre-design/pre-lodgement meeting
OFFICIAL USE ONLY
Important information for applicants
DATE RECEIVED
FILE REF
PROJECT REF
COMPLETE FORM
A pre-design/pre-lodgement meeting will help you identify relevant
environmental issues and the principles of sustainable development early in
the planning stage of your proposal and will help the Department of
Environment and Heritage Protection understand the level of impact or
significance of the project.
(Commercial and confidential information must be marked clearly)
Applicant details
ENTERED BY [SIGNATURE]
DATE
1
Name of applicant
PRINT FULL NAME:
GUIDE
1.
2.
3.
4.
The ‘applicant’ is the persons,
or registered legal entity (not a
business trading name)
intending to carry out the activity
and in whose name the
applicable permits or licences
are to be issued.
If the applicant is a registered
entity, enter name and title of
the principal contact person for
the application (e.g. John
Jones, Managing Director).
All bodies registered under
corporations law, will have an
Australian Business Number
(ABN) or Australian Company
Number (ACN).
Please make sure the contact
details provided are those by
which you can be contacted on
a daily basis.
2
Responsible person/appointed signatory
PRINT FULL NAME/TITLE:
3
ABN/ACN
ABN/ACN:
4
Address and contact details
FULL POSTAL ADDRESS:
PHONE:
FAX:
MOBILE:
EMAIL:
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ABN 46 640 294 485
Form
Application for a pre-design/pre-lodgement meeting
Project details
5
Description
Briefly describe the proposal including any options being considered. Please indicate where there is scope for
project modification. Technical reports or other planning work may be helpful in resolving issues about
feasibility. Briefly describe the processes of your project as they relate to energy and water use and waste
outputs and any other environmental issues that may be affected by the project. Attach any relevant
information.
DESCRIPTION:
6
Proposed site location(s)
Where several site options are being considered, list all the alternative sites. Give as much information as
possible to accurately locate the site(s), for example maps with contextual or boundary lines on plan or GPS
boundary co-ordinates. Include surrounding areas and attach any relevant information.
DESCRIPTION:
7
Offset requirements
Is an environmental offset required (e.g. vegetation offset, biodiversity offset, Koala offset)?
Yes
No
Don’t know
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Department of Environment and Heritage Protection
Form
Application for a pre-design/pre-lodgement meeting
8
Applicant’s certification
 I understand that information supplied on or with this application form may be disclosed publicly in
accordance with the Right to Information Act 2009 and the Evidence Act 1977.
PRINT NAME AND POSITION OF SIGNATORY (E.G. MANAGER, OWNER, PARTNER, CEO):
APPLICANT’S SIGNATURE:
DATE:
Thank you for taking the time to complete this form. An officer will contact you to arrange a pre-design/prelodgement meeting. Please return your completed application form to:
Permit and Licence Management
Implementation and Support Unit
Department of Environment and Heritage Protection
GPO Box 2454
Brisbane Queensland 4001
Enquiries: 1300 130 372 (Option 4)
Email: palm@ehp.qld.gov.au
Privacy statement
The Department of Environment and Heritage Protection (EHP) is committed to protecting the privacy,
accuracy and security of your personal information in accordance with the Information Privacy Act 2009. EHP
is collecting your personal information in order to tailor the meeting to best facilitate your application. The
information will only be accessed by authorised employees within the department. Your information will not be
given to any other person or agency unless you have given us permission or we are authorised or required by
law. All information supplied on this form may be disclosed publicly in accordance with the Right to
Information Act 2009 and Evidence Act 1977. For queries about privacy matters email:
AdminReview@ehp.qld.gov.au or telephone: (07) 3330 5448.
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Department of Environment and Heritage Protection