2017-05-04_Request for Extension to Relevant Period_REV A · 152006.1999

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 191                 Street Hollett Road
Suburb Noosaville                                                            State QLD                   Postcode 4566
Lot no.                       Plan type & plan no.
53                            SP163571




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
SARA – Department of Natural Resources and Mines                                              04 May 2017
SARA – Evironmental Protection Agency                                                         04 May 2017



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
                                                                        Date
Owner’s name/s
                                                                        Table B – owner’s consent provided on form
I/We, the above-mentioned owner/s of the land, consent                                       John Stuart Hofmann
to the making of this request.                                          Owner’s name/s
                                                                                             Kathleen Mary Hofmann
Signature/s                                                              The owner’s written consent is attached.




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