Request to Change Existing Approval.

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

'&f To change the development |X 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. A |StreetNo 21 [Street YENEE pewE
Suburb WcOSaAnLLe State GLO Postcode S64

  
  

 

 

Plan type & plan no.

4 | SP 2G 0OF4

 

 

 

 

 

 

 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval? LYNo
O 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?

CINo [efYes Conc, Ranved (ema).
If yes, please attach a copy of the notice.

 

 

 

  

7. Owner’s consent

   

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

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

 

 

 

     

  

Table B— owner’s consent provided on form

 

| Table A — owner's consent provided an fo

 

 

 

 

 

 

 

'
X = ss

C Owner's name/s Sast os. = ms Owner's name/s
oe USO ONS
|) "We, the above-mentioned owner/s of the land, consent int O The owner's written consent is attached
tc to the making of this request. -
(aE — ofr YK - ee

MX Aare SSeS

¢ Signature/s Ltt ae ice

C

 

Date |

ge elélm

 

 

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