132004.240018.A - Request to change an existing Approval

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                                                                                                                           Suslalnable Planning Act 2009

I',""-,.ALLqueslions      MUSTbe i:ompl~i;d~nless the f~;;;;indicales otherwise... '
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I this    formmust be submitted 10 Councilaccompanied by the applicablefea....                                           ...       ,':,.:.:,,;.'.', :'... " .. '
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                                                                     th~:ap'prov~iwa~IS~~e.'Jby Ihe c~~:me~::.:                                       .
I (a) a request to changa tha davelopment approval andlor condltlonsfs mada 10tho Court;ond ,,..:.'....~<';"i"'::. ,:.. .


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Full name -lndl~ldual or company                    f'~-r~             <    '10     ~
ContaclName-forcompany                       NI'''T\l~             N\l_~
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                       fb 1So'l'- 10;58
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Postal address

                                                                ~h~ne ~--"-IStateQ~-Mo~le                                ~-[postcode               -TjOO6--'-'
Email address          ~~J~L.~.,"""" ...                                    G.A.J                              ! Fax                                                    ...


Type of approval (please tick ALL applicable categories)                                Which entity Issued approval?
iii' Development Permit                                                                 rs(' Council
o     Preliminary Approval                                                              o   Other entity - pleasa spaclfy
o     Compliance         Permit
Fi Material Change of Use
~     Reconllgurlng a Lot
o     Operational Works
o     Building Works
o     Plumbing or Drainage Works
o     Compliance         Certlficale
o     Environmentally          Relevant Activity
Application numberlcouncll reference _,~~      •.~,?,?\~:~                                  (~Sb}l,9j:~T~_-::-]
                                                                                                           Date.!~sued07 :.?If _~l_.~                          <


Is the approv~mo?!I:...and      temporary ERA?             '-<                                         !if No                  0      Ves - complela below
Insert tha name of each local government area in which the _n1.0,,!I
                                                                 •.!'~~_t~mporary ER:~_ispropos".'!..t? ?I'~~teloperatinl!....




Privacy
Council will use any porsonallnformalion provided tor lhe intended purposo only and tor remainIng In contact Yoilh you. Council 19aulhorised to collect
this Infonnalion in accordance 'Ni\h the Local Governmenl Act 2009 and olher Local GovemmelJt A<;ls. Your personallnk'llmallon Is only [lcl,;Cssed by
pP.f!;MS RlJlhorised to do so, Your personal informallon Is dealt .•.•ilh in il.ccllrdanc:e wllh councts p,ivocy policy.

WWN   naasa aId gav au
pn Br'llC 141 TowOlnlln 01(1.4565
                                             I   [email protected]
                                                                                              I
                                                                                               T 07 53296500
                                                                                                  AAN 97 96r12111 121

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