NSC Form Stage 1_001

3. Nature of request (please tick ALL applicable categories)
O_ To change the development O To change the development M 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. StreetNo 36 Street £AcM R2AC
Suburb NOOSA NORTH SuoRe State QLD Postcode 4565
Lot no. Md ns | tk Uo

Zz GPiBE1E9

 

5. Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval? O No
WYes-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 PCr) Sasha)

DEPaRIMEM OF ENNIRONMENT Awd RéSaede MANAGEMENT AT BAN Of LODsEMENT TO
COUNCIL

6. Pre-request response notice

 

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
WNo ‘O Yes
If yes, please attach a copy of the notice.

Yam ey namely Las
ls the owner's consent required for this request? ONo

WYes— 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

i i p 7D
Owner's name/s “Owner's namels Ni 7 MocDINGS PI Ui

IWe, 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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