130814 Permissible Change Request Final · MCU14/0073

i

3. Nature of request (please tick ALL applicable categories)

BI To change the development 0 To change the development ‘a 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. _ Street No 971 __ ‘Street Lake Macdonald Drive

Suburb ‘Lake Macdonald | State QLD “Postcode 4563

 

    

- SP108094

 

    

 

 

 

5. Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval?

 
 
 
    
    

Note - Under 5372 of the Sustainable Planning Act 2009:the person
concurrence agenci

‘Department of State Development, Infrastructure and Planning

 

 

 

 

      

6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
ANo ‘Yes
- if Fyes; ‘please- attach. a copy. of the notice.

Te ON Ua ecu

Is the owner's consent required for this request? Ri No
0 Yes— complete either Table A or Table B below
Note — If more than one owner of the land < alt owners’ details are required

 

 

 

   

 

 

 

 

       

Owner's name/s ------nrnrrrn

 

Owner's name/s

 

 

 

lo
Oo

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

 

   

| Signature/s

 

 

Date

 

 

 

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