06/2159 - Change to Development Approval [As Published] · 142006.2159.02

 

 

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INTEGRATED PLANNING ACT 1997 Form 2, Version 4.1, 3 March 2008 3c
3(b) Can the address be further described by shop/tenancy number or storeyAevel? ha
C1 No (ss Yes~ Complete Table C ee
Table C| — Shop/tenancy number Storey/level :
1.
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4. Can the premises best be identified by coordinates (e.g. for development proposed in waters, or on a site within a farge rural lot)?

 

 

 

     

 

 

 

 

 

 

 

 

 

 

   

 

(1 No CO Yes - Complete Table D

» Table D

, eel By et Oe Coordinates? , Tee le "

. 4 oo Me a Note: place each sel of coordinates in a separate row) . ft Rete we Datum ee ie anh area

* “Basti peNerthing “4 |" Catitude k=] "6 Longitude: **]. rie Wee le pmene ’
ae feed # os ‘ * . Cicpas Cl wess4 . wale
1 aren a * ’ } ae |, te 4 eo da ya. '° . La

“ rn we sf 2 4 . . . i “ ou

rT fa ae “ ) WJ Other te ft As ee e

‘ 5. Whatis the total area that makes up the premises fie the area covered by the application)?

‘bog

Ce ete

Owner's’ consent and!

 

Area in a water body or watercourse

 

 

   
 

 

 

 

 

 

Em? CE) hectares (Tick applicable unit)

 

   

 

6. Is the person making the request the owner ‘of the and to which the approval attaches?

Yes oO No — Complete Table E - provide details for each owner an a separate row. or on an attachment to this form if applicable, Note: Advice
provided at the end of this form details when owner's consent is not required.

 

TableE | . “| Details of the premises owned “ean ] pate consent
L Owners namels and postal address ; {sitbét address or fon plan description). Signature was obtained

ae one mi . ann on lt

7. \fan application for the existing approval were being made now (i.e. at the time of making requ! would evidence be:required to

 

 

 

 

 

 

 

 

 

 

 

 

support the application because it involved taking or interfering with a State-owned resource prescribed by schedule 10 of the rn)
Integrated Planning Regulation 1998 (IP Reg) or any other regulation y
YY No O Yes ~ Complete Table F and submit, with the application, waitten Sarooment to the request. si? ve
TEE -
py . ee MS ay ne . se.
e@ Table F Yl Nature ofiState wned C “las Relevant State Government Department Date writen agreement ofthe chet | oe

   

te ot executive was.obtained» *
sit a ™ A t

 

 

 

 

 

 

 

 

        

8 Whatis the nature at the request for change? (Tick the applicable box/es)
Mea extension of the period before an ‘approval. lapses (under IPA — *
To change the development approval other than a change of condition (under IPA, section 3.5.24)
O To change or cancel a condition of approval (under IPA, section 3.5.33) - Go fo Q17 tee

1 To change conditions of a rezoning approval given under the Local Government (Planning and Environment) Act 1990 (under IPA,
section 6.1.35) - Go fo Q12

 

9, Were one or more concurrence agencies involved in the approval?

 

* owner's signature can not be provided on the form if you intend to submit the apptication electronically. Owner's consent must be provided to the assessment manager on a
an attachment containing appropriate written documentation of the owner's consent. If the owner is a company the company must sign as owner. S127 of the
Corporations Act 2001 (Cwealth) details how a company may execute a document.

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