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Pre Request Response Form (Deck) 132003.221152.7
Pre-Request Response Application
Planning Act 2016
ALL questions MUST be completed unless the form indicates otherwise.
This form must be submitted to Council accompanied by the applicable fee.
Attach extra pages if there is insufficient space on the form.
All terms used on the form have the meaning given in the Planning Act 2016 or the Planning Regulation 2017.
1. Details of person making the request
Full name – individual or company Mr Greg Woolley
Contact Name – for company C/ Max Bartho
Postal address Po Box 670
Suburb Coolum Beach State Qld Postcode 4573
Business phone 54462185 A/H phone Mobile 0412710855
Email address [email protected] Fax
2. Details of existing approval
Type of approval (please tick ALL applicable categories) Which entity issued approval?
Development Permit Council
Preliminary Approval Planning & Environment Court
Material Change of Use Minister (under part 11, division 2)
Reconfiguring a Lot Other entity – please specify
Operational Works
Building Works
Plumbing or Drainage Works
Environmentally Relevant Activity
Application number/council reference 23643 DA Date issued 12.08.2004
Is the approval for a mobile and temporary ERA? No Yes – complete below
Insert the name of each local government area in which the mobile and temporary ERA is proposed to operate/operating
3. Nature of proposed change/s (please tick ALL applicable categories)
To change the development approval issued by: To change the conditions issued by;
Planning & Environment Court Planning & Environment Court
Minister Council (as a Concurrence agency)
Other entity – please specify: Minister
Concurrence Agency – please specify:
Other entity – please specify:
Please attach documentation outlining the detail of and the reasons and justification for the requested change/s.
Privacy
Council will use any personal information provided for the intended purpose only and for remaining in contact with you. Council is authorised to collect
this information in accordance with the Local Government Act 2009 and other Local Government Acts. Your personal information is only accessed by
persons authorised to do so. Your personal information is dealt with in accordance with council’s privacy policy.
www.noosa.qld.gov.au [email protected] T 07 5329 6500
PO Box 141 Tewantin Qld 4565 ABN 97 969 214 121
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4. Location of the premises
Unit No. Street No 12 Street Park Road
Suburb Noosa Heads State Qld Postcode 4567
Lot no. Plan type & plan no.
54 RP52918
5. Declaration of applicant
I/We, the applicant, declare that the above information is correct in all respects, at the time of lodgement of this
application with Council. Should any of the details given in relation to this application be changed in the future, the
applicant shall advise Council in writing prior to any such change being implemented.
Signature Date 09.05.2018
OFFICE USE ONLY
Application no. Amount paid Date paid Receipt no. Initial Date stamp
Receiving Officer
Payment options
In person 9 Pelican Street, Tewantin: 8.30 am to 4.30 pm Monday to Friday (excludes public holidays).
By mail Cheque or money order to be made payable to Noosa Council.
Cheque Money order Mastercard Visa
Card number Expiry date Amount $
Name on card Signature of cardholder
Phone Is a receipt required? Yes No
All payments made by credit card will incur a 0.50% surcharge (exempt of GST) to reflect the cost of fees charged for credit card
transactions.
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