Consent form 02 · 51989.1272.03

EarthCert°

PO Box 432, Pomona QLD 4568 * Ph 07 3063 9391 ° [email protected] * ABN: 49 162 782 014

OWNER’S CONSENT TO LODGE

, % , fi . d
L Fahen's Conrad Klien aud Leaune Lela _ owner/s of

 

{ Taremert court Mosrecx! k 456 F _, sive EarthCert Pty Ltd

permission to lodge the planning application for the proposed building work at the above
address on my behalf.

C

Signed

   

Name:
Date: