Request to change existing approval OPW16/0028.01

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

O Tochange the development —Y 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

Unit No. StreetNo A/F
Suburb MOEA VILE

Lot no. | Plan type & plan no.

BLO SP ORS 77

. te YSCL

   

5. Concurrence Agencies

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

Concurrence Agency oe y es copy given

6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
ONo O Yes

If yes, please attach a copy of the notice.

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

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

Table A — owner’s consent provided on form Table B — owner’s consent provided on form
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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NOTES: For question 7

Under section 371 of the Sustainable Planning Act 2009, if the person making the request is not the owner of the land to which the
approval relates, the request must be accompanied by the owner's consent.

However, owner's consent is not required if the approval:

- relates to land the was acquisition land to which section 263(2)(d) of the Sustainable Planning Act 2009 applied when the
application for the approval was made; or

- is for building work or operational work for the supply of community infrastructure on land designated for the community
infrastructure; or

- the consent of the owner would not be required under section 263(1) of the Sustainable Planning Act 2009 if a development
application were made for the requested change.

Also, owner's consent is not required if the Assessment Manager is satisfied that:

- the number of owners of the land make it impractical to obtain owners’ consent, and the requested change does not materially
affect the owners’ land; or

~ having regard to the nature of the proposed change, the owner has unreasonably withheld consent and the requested change
does not materially affect the owner's land.

  

8. Does the request involve a State resource prescribed under the SustainablePlanning Regulation 2009,
Schedule 14?

LYNo
Nature of State owned resource:
Nature of Evidence required:

    
      

C1 Yes — complete below details

O Evidence of allocation of / entitlement to, the resource 1 Evidence the chief executive has agreed to the request
Attach a copy of the evidence required above
NOTES: For question 8

Section 370(3) and (4) of the Sustainable Planning Act 2009 requires that if an application for the development approval were made at
the time of making this request and evidence under section 264(1) of the Sustainable Planning Act 2009 would be required to support
the application, this request must be accompanied by the written agreement of the chief executive from whom evidence would be
required under section 264(1).

Section 264 of the Sustainable Planning Act 2009 provides that if a development involves a State resource, a regulation may require
the application to be supported by certain evidence prescribed under regulation. Schedule 14 of the Sustainable Planning Regulation
2009 prescribes the State resources for which evidence is required to be given, and the evidence required, to support the application.

9. Declaration of applicant

We, the applicant, declare that the above information is correct in all respects, at the time of lodgement of this
application with Coyfcil. Should any of the details given in relation to this application be changed in the future, the

applicant shall advj > Cguncil in writing prior to any such change being implemented. ,
Date 504 [Zab :

  

Signature/s

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