img-211104136-0001 · 131999.982996.1

   

 

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

WY To change the development io To change the development Ol 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 a
: extension.

    
  
 
 
 

   

[vt
Unit No. Sugsrariom “ [StreetNo 5) Street HasTINGS ST

Suburb Noogh HeMhS | State | Postcode
el aiten i Plan type & plan ee

b RPAFAS  Coowry Of MARSH PARISH aC weYBh

 

  
    

   

 

 

 

 

 

 

 

   

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

: 0 Yes-provide details below
Note — Under 372 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
i

 

 

 

 

 

 

 

 

 

 

  

6. Pre-request response notice
Hag-a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
PNo | UO Yes

 

 

 

If yes, please attach a copy of the notice.

EYNo

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

 
  

 

 

0 Yes— complete either Table A or Table B below

a

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 1 The owner's written consent is attached.
to the making of this request.

 

 

 

 

 

Signature/s

 

 

 

 

 

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