132005.2124.3 Request to Change an Existing Approval - part 1 of 2 IDAS form - 41 Hastings St Noosa Heads

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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



                                                                                      LI GDA94

                                                                                      1-1    WGS84

                                                                                      El Other




5. Details of the proposed change


'e 3t G      Sin              G?Q to     Gl, 3c            \ tti                            alS h

  (c (=e,3            ct, v       c I   tac (-•e d
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6. Is owner's consent required for this request? (refer to notes at the end of this form for more information)


       No

r1ul
I -N   Yes-complete either table D or table E as applicable        j/jr FG 3              CMS

Table D

Name of owner of the land                                                                       Co e c AZ, r e

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

Signature of owner of the land



Date


Table E

Name of owner of the land


q The owner's written consent is attached




              3                                                          Request to change an exiv;!ing aJ;p ;Vai template
                                                                                                  Version 1.1 March 2010