DA Form 5

                                                                  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 relevant to the original development approval and their details 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
                                                                                              Ipswich City Council
     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):
Patios

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


PART 5 – MINOR CHANGE APPLICATION REQUIREMENTS
7) Are there any affected entities for this change application
   No – proceed to Part 7
   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
                                        request response notice for the application has         pre-request response
                                        been given, a copy of the notice must                   provided)
                                        accompany this change application)
                                            No
                                            Yes – pre-request response is attached to
                                        this change application
                                            No
                                            Yes – pre-request response is attached to
                                        this change application
                                            No
                                            Yes – pre-request response is attached to
                                        this change application




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                                                                                      Planning Act Form 5 - Change application form
                                                                                                      Version 1.1 — 22 JUNE 2018