NC extension form signed · 152006.862.02

24.04.2014
24.04.2014
 24.04.2014


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APR Lec cia (eae eae Ga ica categories}

{1 To change the development ci To change the development cr 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 ofthe premises
Unit No. Street No 1270 Street | McKinnon Drive

Suburb —_ Ringtail Creek State Ald Postcode 4565

 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval? ii No
0 Yes-provide details below

Note ~ Under $372 of the Sustainable Planning Act 2009 the person making the request i is required to give a copy of this request to all
concurrence agencies.

    

GoricurrenceAgency.

_ Department of Natural Resources 24.04. 2014
24.04.2014

Environmental Protection Agency (DERM)

DP! & Fisheries 24.04.2014

6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
ho : : 1 Yes . ve

If yes, please attach a copy of the notice.

WemOl lacie melt lane

Is the owner's consent required for this request? O No ;
Wres- complete either Table A or Table B below

Note ~ If more than one owner of the land all owners’ details are required

    

bedey OUR oT is provided Colt old aes Be Ue consent provided on'form:

Ora w ? fA. “a he AA Owner's name/s

\We, the above-mentioned owner/s of the land, consent (i The owner's written consent is attached.

to the making of this request.
Date a3 /4 [20/4

 

Owner's name/s

  
 

Signature/s

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