Amended application form showing common property 51988.57.04

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

@ Tochange the development Ol To change the development O 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

UnitNo. S Street No &/ Street HMacnvGS  SrreeT~
Suburb Won Hemp Stae G@cO

   
 

   

   

 

Postcode 456

   

  
 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval? No
0 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.

   

6. Pre-request response notice
Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
MNo 0 Yes

If yes, please attach a copy of the notice.

7. Owner’s consent
Is the owner’s consent required for this request? No

0 Yes- complete either Table A or Table B below
Note — If more than one owner of the land all owners’ details are required

 

Cee

 

Bee ese

 

Owner’s name/s Owner's name/s

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

Signature/s

Date

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