001AC752.001

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        INTEGRATED PLANNING ACT 1997                                                                              Form 2, Version 4.1, 3 March 2008
             3(b)  Can the address be further described by shopitenancy number or storey/level?
                   [SJ  No         ]     Yes— Complete Table C
                     Table C      Shop/tenancy number            Storey/level

         4.  Can the premises best be identified by coordinates (e.g. for development proposed in waters, or on a site within a large rural fot)?
             [)   No          (J Yes — Complete Table D
         Table D
             RT Sat                    Cbordifiatés                         |.    26    ,                                                       ;
             RNS | (Note: place each séf of coordinates in a Seperate row) — _Ip ane cal:        Datum            -              aie         —
       1.                                                                               1 Goas4 (] wosa4
                                                                                        (7) Other
         5.   Whatis the total area that makes up the premises (ie, the area covered by the application)?                                              Lo
           “Area ol fand above high water markoutside waterodurse                  ss.      7 Atea.ina water body or watercourse?       a SB]         =
                                     Pees!    Kp      ee et ee    ae EG                                mn ET a Te faassen      Be the 0 Sas SNS hme   eos
                                     (Ca) m2: ? Cal hectares (Tick appticabie unit) -                ET 2: E2]        hectares |   cable ui) cee)   OOS
                                     yay as RL see i               ett  a   -                        Pa     See       Bath Ce DAD SE          age         4
        SERRE OTR    T ATONE TERE TE REE TENT NATIT ETE       TFL ron gt SE   en      rep BODOG      Ke Nag NON ROHR                CRE ECT                .
        EGumsee gongent ad wosouree owners agreement aap ney                  mae   Rea ee Sn            Si ea ance                   Rene              a
          6.  Is the person making the request the owner of the land to which the approval attaches?                                  Pa               Pea  by
               ml Yes           Xx  No - Complete Table & - provide details for each owner on a separate row, or on an attachment to this form if applicable. Note: Advice. 5
                                      provided at the end of this form details when owner's consent is not required.                                       ome
         TableE    [RR er we                           oT OS Bis of the premises wens Ie ys                         :             1   Bate og            og
                   LES Ogifer's namels and postal address. |, Detalls.of the premises owned                 ignature®           - - | Date consent,        ao
                    ‘eos Quer s namels and postal adress  | steel address ll om plan deserption) | °°    Signature                   was obtained |     =. 7
           .       Py       Sie Sheri, A RE ES           ES ee                  .    _       :                -                     Le     oan
               1.)    DEBBIE          Kvé6éis
                     3/ye7 TooRAK                   RD |      As     abot                                                            rn} 4/4
                         00 KAT FS,     eh, Cc. J /' 2                                        .
          7.   If an application for the existing approval were being made now (ie. at the time of making this request), 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                .
               Integrated Planning Regulation 1998 (IP Reg) or any other regulation                                                                          "
             ‘ Bd    No         [1   Yes - Complete Table F and submit, with the application, written agreement to the request.
                    rr  aoa SEM Ran a SAR   ME atta ee AEE a Pa        gee ONES SR         ame ee yk ode    uf DE TEMES pathos ee 40 ah                       :
           Table F |    ~~ °:Nature'of State-owned resource’ <<». ["--* Relevant State Goverment Department =.   Date written agreement of the chief        .
      .               1a ee SA ey ca Re Oa                  RIE Pig 2 a        RR ate Neh inn          Bet re         written agréermient 6   iets
                        eee ee         Cetin nae               of    et  ak Pige      Teeae ree oes Bea]           SS OReeaMVe BS ODEEINER                 -
             ae                                                                                                                                               |
         Setemegemrectet wm epee NP RN eee LE aE APN, BT, ga tlle Mla Gi 2, a yt Ponsa TASER     gotta ty   ord Ep GARE 8     ORE ge PE gt
         cNaturelot thereauest     0085 Se                 REGS SABO           ith         te         Sou         ye Se este                                -
           8.   Whatis the nature of the request for change? (Tick the applicable box/es)                                         .
               x      An extension of the period before an approval lapses (under IPA, section 3.5.22)
                oO   To change the development approval other than a change of condition (under IPA, section 3.5.24)
                [1   Tochange or cancel a condition of approval (under IPA, section 3.5.33) - Go to Qt
                (1    To change conditions of a rezoning approval given under the Local Government (Planning and Environment) Act 1990 (under IPA,
                      section 6.1.35A}- Go to Q72                                                                                 .
           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 application electronically. Owner's consent must be provided to the assessment manager on
              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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