Department of Natural Resources and Mines Application form Remove obvious map errors on the proposed SCL trigger map — Map amendment If you think the proposed strategic cropping land (SCL) trigger map has obvious map errors in your particular area of interest, you can apply to the Department of Natural Resources and Mines (DNRM) to amend the map using this form and following the department’s map amendment process. An obvious mapping error is an area for which a SCL criteria assessment is not required and is easily visible on an aerial or satellite image. Examples of this include existing open cut mines, power stations, major dams, quarries, licensed wastewater storages, holding ponds and airports. No application fee is required. See the DNRM website <www.dnrm.qld.gov.au> for a copy of the proposed trigger map and information on the map amendment process. Guide for applicants If you have any queries about how to complete this form correctly, please contact the department using the contact details provided at the end of this form. Specific information requirements 1. Applicant details Name: ABN (if applicable): ACN (if applicable): Address: Suburb: Postcode: Phone: Fax: Email: 2. Contact person for this application Name: ABN (if applicable): ACN (if applicable): Address: Suburb: Postcode: Phone: Fax: Email: The contact person may be a consultant or some other person acting on behalf of the applicant. If a contact person is nominated, all dealings and correspondence with the applicant(s) will be through the contact person. Official use only Date received: File ref.: Project ref.: Complete form: Correct AA: Complete fee: Administering region: South Page 1 of 3 – Form 2 - Version 1 North 06/2014 Application form Strategic cropping land trigger map —Map amendment Entered by [signature]: Date: 3. Application area details I hold a resource tenure/s over the subject land (list tenure references in table below) AND I have listed the lots and plan description (all lots) details for the land subject to this application below. Please attach additional sheets if required. 4. SCL map requirements Please provide a map(s) of the subject land, made at a scale which clearly shows the areas. Map attached (in PDF or hardcopy) 5. Supporting data To ensure that the information supplied can be accurately positioned, it is recommended that spatial information is provided. It is recommended that this spatial information is in the form of electronic map data of assessment site locations, proposed SCL and non-SCL boundaries and any other information that may be relevant to the application. Please indicate which format these are provided in: ArcGIS shapefile (*.SHP) Google (*.KML or *.KMZ) MapInfo (*.MIF) AutoCAD drawing exchange format (*.DXF) Please note: All coordinates/spatial files should be provided in the GDA94 datum (or WGS84 in some GPS units). Page 2 of 3 – Form 2 - Version 1 06/2014 Application form Strategic cropping land trigger map —Map amendment Declaration I declare that the information contained in this document, including all appendices, is true and correct to the best of my knowledge, information and belief. Applicant’s signature: Applicant’s name: Applicant’s position & company (if applicable): Date: Where the applicant is a company, this form is to be signed by a person authorised (in writing) to sign for that company. Privacy statement The Department of Natural Resources and Mines is collecting the information on this form for the purposes of assessing an application. All information supplied on or with this application form may be disclosed publicly in accordance Right to Information Act 2009 and the Evidence Act 1977. Your personal details will not be disclosed to any other third party without your consent unless required to do so by law. Please return your completed application form, together with all required information to the following email: [email protected] Page 3 of 3 – Form 2 - Version 1 Department of Natural Resources and Mines