Planning Act Form 5

 3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or adjacent to land
      e.g. channel dredging in Moreton Bay)
 Note: Place each set of coordinates in a separate row.
    Coordinates of premises by longitude and latitude
 Longitude(s)                    Latitude(s)                    Datum                          Local Government Area(s) (if applicable)
                                                                    WGS84
                                                                    GDA94
                                                                    Other:
    Coordinates of premises by easting and northing
 Easting(s)              Northing(s)              Zone Ref.     Datum                          Local Government Area(s) (if applicable)
                                                      54            WGS84
                                                      55            GDA94
                                                      56            Other:
 3.3) Additional premises
    Additional premises are relevant to the original development approval and the details of these premises have
    been attached in a schedule to this application
    Not required

PART 3 – RESPONSIBLE ENTITY DETAILS

 4) Identify the responsible entity that will be assessing this change application
 Note: see section 78(3) of the Planning Act 2016
 Noosa Shire Council



PART 4 – CHANGE DETAILS
 5) Provide details of the existing development approval subject to this change application
 Approval type                       Reference number                   Date issued                         Assessment
                                                                                                            manager/approval entity
    Development permit                                                                                      Noosa Shire Council
                                     23185 DA                           1 June 2006
    Preliminary approval
    Development permit
    Preliminary approval

 6) Type of change proposed
 6.1) Provide a brief description of the changes proposed to the development approval (e.g. changing a development
     approval for a five unit apartment building to provide for a six unit apartment building):

 Extension to an Existing Shop

 6.2) What type of change does this application propose?
    Minor change application – proceed to Part 5
    Other change application – proceed to Part 6




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                                                                                                  Planning Act Form 5 - Change application form
                                                                                                                 Version 1.2 — 7 February 2020