Council Form · 132007.2398

 

4. Location of the premises
Unit No. StreetNo \4 | Street Trading Post Rd

Suburb Coaray State ALY Postcode
Lot no. Plan type & plan no.

bP 2 ig are

2 |RO 165 418

 

 

 

 

 

 

 

 

 

 

 

Was there one or more concurrence agencies involved in the original approval? O No

 

Wes-provide details below

| Note — Under 8372 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 Date copy given

SABA ef bf ib

 

 

 

 

 

 

 

6. Pre-request response notica

aa a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
EMKio | 0 Yes
If yes, please attach a [If yes, please attach a copy of the of the no notice.

ree Teme

Is the owner's consent required for this request? ONo

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

Table A — owner’s consent provided on forr

Owner's name/s Owner's name/s

 

 

 

 

 

 

 

   

Table B — owner's consent provided on fornt

Waltec EWiot Holdings

 

 

 

 

 

 

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

 

 

 

Signature/s

 

Date

 

 

 

 

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