Change Application Form 5

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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.

| LJ Coordinates of premises by longitude and latitude
Longitude(s) ——__ Lattitude(s) one ee Batum Local Government Area(s) (if applicable)

c Ll wese4
Cl cpaga

LJ Other:

 

 

 

 

| Coordinates of premises by easting and northing

 

 

Easting(s) Northing(s) | Zone Ref. | Datum Local Government Area(s) (if applicable) |
(154 C1 wese4
L155 L] GDA94

 

 

| CL] 56 CJ 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 Peeeeont this change application

 

Note: see section 78(3) of the Planning Act 2016

| Nace — Shv@ |
PART 4 — CHANGE DETAILS

5) Provide details of the existing development approval subject to this change application
Approval type

Reference number Date issued Assessment |
qT, NOe manager/approval entity |
X] Development permit ee ZAIS ,
_] Preliminary approval is |
(_] 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):

 

YS Minor change application — proceed to Part 5
(_] Other change application — proceed to Part 6

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Planning Act Form 5 - Change application forrr
Version 1.2 — 7 February 202C

Page 3

PART 5 — MINOR CHANGE APPLICATION REQUIREMENTS

7) Are there. any affected entities for this change application

PY No — proceed to Part 7

C1 Yes - list all affected entities below and proceed to Part 7

Note: section 80(1) of the Planning Act 2016 states that the person making the change application must give notice of the proposal and the
details of the change to each affected entity as identified in section 80(2) of the Planning Act 2016. |

 

 

 

Affected entity Pre-request response provided? (where a pre- Date notice given (where no pre-
request response notice for the application has been request response provided)
given, a copy of the notice must accompany this change
application) |
L] No

C] Yes — pre-request response is attached to
this change application

L1No
LJ Yes — pre-request response is attached to

this change application |
[1 No

CJ Yes — pre-request response is attached to
this change application

 

 

 

 

 

 

PART 6 — OTHER CHANGE APPLICATION REQUIREMENTS

Note: To complete this part it will be necessary for you to complete parts of DA Form 1 — Development application details and in some instances parts
oFBAFarm ce — Building work details, as mentioned below. These forms are available at https:/planning.dsdmip.gld.gov.au.

 

    

8) Location details - Are there any additional premises included in this change application that were not part of the
original development approval?

 

9) Development ci

Fa eee la NV eral ale (a Com Ul ma ole) Reece: approval Need of assessment in this change :
application?

L] No

_] Yes — the completed Sections 1 and 2 of Patt 3 (Development details) of DA Form 1 — Development application
details as these sections relate to the new or changed aspects of development are provided with this application.

9.2) Does the change application involve building work?
LE] No

Ree |
LJ Yes - the completed Part 5 (Building work details) of DA-Form 2 — Building work details as it relates to the |
change application is provided with this application.

 

10) Referral details — Does the change application require referral for any referral requirements?

Note: The application must be referred to each referral agency triggered by the change application as if the change application-was the original
development application including the proposed change.

L] No \ |
|
|

 

LJ Yes — the completed Part 5 (Referral details) of DA Form 1 — Development application details as it relates to the
change application is provided with this application. Where referral is required for matters relating to building
| work the Referral checklist for building work is also completed

 

 

11) Information request under Part 3 of the DA Rules

[_] | agree to receive an information request if determined necessary for this change application

[_] | do not agree to accept an information request for this change application /
Note: By not agreeing to accept an information request |, the applicant, acknowledge: \

 

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

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