Form 5

 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.
    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 are relevant to the original development approval and the details of these premises 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

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
                                     23116 DA                             12/08/2004                            Noosa Council
    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):

 Refer to attached letter.
 6.2) What type of change does this application propose?
    Minor change application – proceed to Part 5
    Other change application – proceed to Part 6

PART 5 – MINOR CHANGE APPLICATION REQUIREMENTS

 7) Are there any affected entities for this change application
    No – proceed to Part 7
    Yes – list all affected entities below and proceed to Part 7
 Note: section 80(1) of the Planning Act 2016 states that the person making the change application must give notice of the proposal and the
       details of the change to each affected entity as identified in section 80(2) of the Planning Act 2016.
 Affected entity                              Pre-request response provided? (where a pre-                  Date notice given (where no pre-
                                              request response notice for the application has been          request response provided)



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                                                                                                       Planning Act Form 5 - Change application form
                                                                                                                      Version 1.2 — 7 February 2020