Request to Change Existing Approval Form_190916 · MCU13/0030

3. Nature of request (please tick ALL applicable categories)
     To change the development                   To change the development                   To extend the relevant period
      approval                                     conditions                                   before lapsing
Please attach documentation outlining the detail of and the reasons and justification for the requested change or
extension.


4. Location of the premises
Unit No.                      Street No 20                  Street Topaz Street
Suburb Cooroy                                                                State QLD                   Postcode 4563
Lot no.                       Plan type & plan no.
102                           SP236318




5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval?                   No
                                                                                                Yes-provide details below
Note – Under s372 of the Sustainable Planning Act 2009 the person making the request is required to give a copy of this request to all
concurrence agencies.
Concurrence Agency                                                                             Date copy given




6. Pre-request response notice
Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
 No                                                             Yes
If yes, please attach a copy of the notice.


7. Owner’s consent
Is the owner’s consent required for this request?                   No
                                                                    Yes– complete either Table A or Table B below
Note – If more than one owner of the land all owners’ details are required


Table A – owner’s consent provided on form                              Table B – owner’s consent provided on form

Owner’s name/s                                                          Owner’s name/s

I/We, the above-mentioned owner/s of the land, consent                   The owner’s written consent is attached.
to the making of this request.

Signature/s


Date




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