Changes Application Form - TPC 2563 - Adding Sun Room - 1/2 La Maison Neptune Circuit Noosaville · 51993.587.04

                                                                                                Department oflnlrastlUclure. local Government and Planning


Privacy _ Personal infonnation collected in this foon will be used by the responsible entity and/or chosen assessment
manager, any relevant affected entity or refenal agency and/or building certlfler (including any professional advisers which
may be engaged by those entities) while processing, assessing and deciding the change application.
All infonnation relating to this change application may be available for inspection and purchase, and/or published on the
assessment manager's and/or referral agency's webslle.
Personal infoonation wiD not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Ragulation 2017 and
the DA Rules except where:
• such disclosure is in acoordance with the provisions about public access to documents contained in the Planning Act
    2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and Planning
        Regulation 2017; or
 •      required by other legislation (including the Right to Information Act 2009); or
• otherwise required by law.
This infonnation may be stored in relevant databases. The Infonnation collected will be retained as required by the Public
Records Act 2002.


PART 7 - FOR OFFICE USE ONLY

 Date received:            ~                                           I Reference number(s):
 OleE1v(. nol.flC.atlorl and payment
 N,J"    F,'"   ,d'i
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 Description of the wof1<
 QLeave project number
 Amount paid ($)
 Date paid
 Date receipted foon sighted by assessment manager
 Name of officer who sighted the fonn

The Planning Act 2016. the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This fonn and all other required change application materials should be
sent to the responsible entity.




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                                                                                                              Planning Act Form 5 • Change eppllcation form
                                                                                                                                   Version 1.G-3 July 2017