Permiss change form signed · 132006.1395.04

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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