Request a Change to Existing Approval & Response to Show Cause Notice -142008.1704.4

Table C-premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g. channel
dredging in Moreton Bay)

Coordinates                                                           Zone         Datum             Local government
(note: place each set of coordinates in a separate row)               reference                      area (if applicable)
Easting         Northing          Latitude          Longitude



                                                                                   q     GDA94

                                                                                   q     WGS84

                                                                                   El Other




5. Details of the proposed change

    Attached




6. Is owner's consent required for this request? (refer to notes at the end of this form for more information)


El No

       Yes-complete either table D or table E as applicable
I


Table D

Name of owner of the land

I, the above-mentioned owner of the land, consent to the making of this request.

Signature of owner of the land



Date                                         30 May 2011




Table E

Name of owner of the land

[X] The owner's written consent is attached