DA Form 5 Change application form

3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or adjacent to land
e.g. channel dredging in Moreton Bay)
Note: Place each set of coordinates in a separate row. Only one set of coordinates is required for this part.

☐ Coordinates of premises by longitude and latitude
Longitude(s)                              Latitude(s)                    Datum                           Local Government Area(s) (if
                                                                                                         applicable)

                                                                         ☐ WGS84
                                                                         ☐ GDA94
                                                                         ☐ Other:
☐ Coordinates of premises by easting and northing
Easting(s)                   Northing(s)              Zone Ref.          Datum                           Local Government Area(s) (if
                                                                                                         applicable)
                                                      ☐ 54               ☐ WGS84
                                                      ☐ 55               ☐ GDA94
                                                      ☐ 56               ☐ Other:
3.3) Additional premises
☐ Additional premises relevant to the original development approval and their details have been attached in a
schedule to this application
 Not required
PART 3 – RESPONSIBLE ENTITY DETAILS
4) Identify the responsible entity that will be assessing this change application
Note: see section 78(3) of the Planning Act 2016
NOOSA COUNCIL ON BEHLAF OF PACIFIC BCQ

PART 4 – CHANGE DETAILS
5) Provide details of the existing development approval subject to this change application
Approval type                      Reference number              Date issued                                            Assessment
                                                                                                                        manager/approval
                                                                                                                        entity
 Development permit                                                                                                        NOOSA SHIRE
                                                     UNNOWN                                 UNKNOWN
☐ Preliminary approval                                                                                                        COUNCIL

☐ Development permit
☐ Preliminary approval
6) Type of change proposed
6.1) Provide a brief description of the changes proposed to the development approval (e.g. changing a development approval
for a five unit apartment building to provide for a six unit apartment building):

ALTERATIONS AND ADDITIONS TO DWELLING UNIT TO ENCLOSE AN EXISTING VERANDAH INTO A HABITAL
ROOM AND INCREASE GFA.
6.2) What type of change does this application propose?
 Minor change application – proceed to Part 5
☐ Other change application – proceed to Part 6




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                                                                                                    Planning Act Form 5 - Change application form
                                                                                                                    Version 1.1 — 22 JUNE 2018