01072015144724 · MCU10/2065

 

4. Location of the premises

Unit No. [StreetNo \7q | Street Growt Stree

Suburb Nloo sa State QLD | Postcode ASE
) : eld ai elon :
\\ SPoimag7a

 

    
 

      
 

         

 

 

 

 

 

 

 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval?

 

Weswiovile details below

Note — Under $372 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 Oisy ee : a LS Date copy en aS

KAA Developmen Managers

 

  
 

 

 

 

 

 

 

 

6. Pre-request response notice ;

Has-a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
No QO Yes
If yes, please attach a copy of the notice.

7. Owner's consent

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

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

 

 

 

 

 

 

 

 

      

 

Owner's name/s

 

“lier ss owners hemels
c\\ Fave

MWe, the -povemotvones mine a the land, consent Fyyae ol The owner's written consent is attached.
to the making of this request.

BOLI ZZ

Date I“ T-AS

 

 

 

 

 

Signature/s

 

 

 

 

 

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