Request for Change to Development Approval 51975.3702.03 (TPC 545)

    To change the development                  o   To change the development                o    To extend the relevant period

    approval                                        conditions                                   before lapsing

Please attach documentation outlining the detail of and the reasons and justification for the requested change or
extension.




                                   ~\l? 2-550




Was there one or more concurrence agencies involved in the original approval?

                                                                                                o Yes-provide details below

Note   -
         Under s372 of the Sustainable Planning Act 2009 the person making the request is required to give a copy of this request to all
concurrence agencies.

Concurrence Agency                                                                              Date copy given




6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?

~                                                                IOYes
If yes, please attach a copy of the notice.




Table A    -
             owner’s consent provided on form
                                                                          Date

Owner’s name/s
                                                                         Table A   -
                                                                                       owner’s consent provided on form

I/We, the above-mentioned ownerls of the land, consent
                                                                          Owner’s name/s
to the making of this request.

                                                                          o The owner’s written consent is attached.
Signature/s




2 of 4     2011/12 Regional Strategy and Planning Request to Change Existing Approval and/or Extension to Relevant Period FM401