Change Application 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.

| 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