Permiss change form signed · 132006.1395.04

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4. Location of the premises

Street No 142 Noosa Drive

Suburb Noosa Heads Qld Postcode 4567
Plan type & pian no.

 

 

SP126203

 

 

 

5. Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval? ONo
[Y Yes-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 Date copy given

Department of Primary Industries and Fisheries

6. Pre-request response notice
Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?

 

If yes, please attach a copy of the notice.

 

7. Owner’s consent

WYes- complete either Table A or Table B below

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

 

Table B — owner’s consent provided on form

   

   

Table A — owner’s consent provided on form

 
 

Owner’s name/s

 
   
 

 

 

| Owners name/s

 

We, the above-mentioned owner/s of the land, consent | OO The owner's written consent is attached.

to the making of this request.

 

  

Signature/s

 

 

Date

 

 

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NOTES: For question 7

Under section 371 of the Sustainable Planning Act 2009, if the person making the request is not the owner of the land to which the
approval relates, the request must be accompanied by the owner's consent.

However, owner’s consent is not required if the approval:

~ relates to land the was acquisition land to which section 263(2)(d) of the Sustainable Planning Act 2009 applied when the
application for the approval was made; or

~ is for building work or operational work for the supply of community infrastructure on land designated for the community
infrastructure; or

- the consent of the owner would not be required under section 263(1) of the Sustainable Planning Act 2009 if a development
_ application were made for the requested change.

Also, owner’s consent is not required if the Assessment Manager is satisfied that:

- the number of owners of the land make it impractical to obtain owners’ consent, and the requested change does not materially
affect the owners’ land; or

- having regard to the nature of the proposed change, the owner has unreasonably withheld consent and the requested change
does not materially affect the owner’s land.

 

  

8. Does the request involve a State resource prescribed under the SustainablePlanning Regulation 2009,
Schedule 14?

Nature of State owned resource:

    
     

  

  
 
 
    
   
   
      
 
    
   

Nature of Evidence required:

 

 

O1 Evidence of allocation of / entitlement to, the resource | Evidence the chief executive has agreed to the request
Attach a copy of the evidence required above
NOTES: For question 8

Section 370(3) and (4) of the Sustainable Planning Act 2009 requires that if an application for the development approval were made at
the time of making this request and evidence under section 264(1) of the Sustainable Planning Act 2009 would be required to support

the application, this request must be accompanied by the written agreement of the chief executive from whom evidence would be
required under section 264(1).

Section 264 of the Sustainable Planning Act 2009 provides that if a development involves a State resource, a regulation may require
the application to be supported by certain evidence prescribed under regulation. Schedule 14 of the Sustainable Planning Regulation
2009 prescribes the State resources for which evidence is required to be given, and the evidence required, to support the application.

 
  
  

 

9. Declaration of applicant

IWe, the applicant, declare that the above information is correct in all respects, at the time of lodgement of this
application with Council. Should any of the details given in relation to this application be changed in the future, the
applicant shall advise Council in writing prior to any such change being implemented.

Signature/s

 
   
 

 

 

 

 

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OFFICE USE ONLY

Application no. Amount paid

Receiving Officer

  

Initial Date stamp

   

Receipt no.

  

Date paid

 

 

 

 

 

 

 

  
 
   
  

     
  

Payment options

In person |9 Pelican Street, Tewantin: 8.30 am to 4.30 pm Monday to Friday (excludes public holidays).

 

By mail Cheque or money order to be made payable to Noosa Council.
O Mastercard '/O Visa

All payments made by credit card will incur a 0.50% surcharge (exempt of GST) to reflect the cost of fees
charged for credit card transactions.

 
  
 

 

 

 

O Money order

 

 

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