Permissible Change Cover Letter, Form and Attachments

4. Location of the premises
Unit No.                      Street No 139                 Street Eumundi Noosa Road
Suburb Noosaville                                                            State Qld                   Postcode 4566
Unit No.                      Street No 30                  Street Lionel Donovan Drive
Suburb Noosaville                                                            State Qld                   Postcode 4566
Lot no.                       Plan type & plan no.
4                             SP159610
31                            SP170751




5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval?                 X No
                                                                                               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                                                                            Date 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?
 No                                                             Yes
If yes, please attach a copy of the notice.


7. Owner’s consent
Is the owner’s consent required for this request?                  X No
                                                                    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
                     Refer to attached correspondence
Owner’s name/s                                                          Owner’s name/s

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

Signature/s


Date




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