23313 DA - Change to development application [As Published] · 132003.220808.2

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—— —— __INTEGRATED PLANNING 3 ACT 4997
Applicant details

Clearly identify who is making the application.
The applicant need not be the owner of the

land.

When signing and lodging this application
The applicant is responsible for ensuring the

information provided is correct. The

assessment manager, any referral agency and
the Chief Executive (where applicable) will rely
on this information when assessing and

deciding the application.

lf the applicant Is a company
A contact person must be shown. All

- corespondence will be mailed to this address,

Form 2, Version 3.3, 29 May 2006

p12” Names =

13.

14.

16.

17.

19.

 

[| caATay
Postal address:
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Signature:

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Contact person:
[CARY 4+ GOANT

Telephone number:
B33, 0973 |

Fax number: (if appiicabie)

TROMEOWN

PROS RET BUSES Myih

15. Date:

(7-9-9)

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18. Mobile number: (applicable)

[f OAs Sis E20 |.

20. Email address: (if applicable)

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Land owner/s consent (if applicable)

+ Section 3.5.24(3) of the IPA requires that the
land owner's consent must be provided if the
person making the request to change an
existing approval is not the land owner.

For information about land awners refer to

Guid ing develop)

ie 1 Making an IDAS development
ication.

application

Land owner's consent is not required for a

mobile or temporary ERA.
fan owner ha: is.

applicant, their signature is not required again

in this section,

there are multiple owners, the consent of

gach owner Is required.

‘Resource entitlement (if appticable)

Sections 3.5.22(4) & (5), 3.5.24(3B) & (3C),
and 3.5.33(3B) & (3C) of the IPA may require
the written agreement of a resource manager if
the request involves a prescribed State
tesource, if when the request was made a
development application for the approval would)
have required evidence of resource entitement

under section 3.2.1(5) of the IPA.

21.

Land owner's consent:
Name in Full

 

Date

29.

Signature

ken DA

 

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. At the time of the request, would a development application for the approval have required:

evidence of resource entitlement?

[DINO - go to a24 (1 YES - go to 023

. Is this request accompanied by the written agreement of the chief executive from whom the

evidence is required? (tick the applicable box)
oO NO - the written agreement of the chief executive must accompany this request

OYes-

 

 

Nature of the request

Any person may request to modify an existing

approval.

24.

25.

This request is for:
An extension of the relevant period for the development approval (s 3.5.22)
(1) To change or cancel conditions (s 3.5.33)
(1 To change the development approval (other than a change of a condition) (5 3.5.24)
(J Achange to conditions of a rezoning approval given under the P&E Act (s 6.1.35)
Provide details of, & justification for, the proposed modification

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Concurrence agencies

Under s3.5.22(1}{a) & 3.5.24(1)(a) of IPA, a
copy of this request must be forwarded to each

concurrence agency for the previous

* application prior to lodgement of this form with

the assessment manager.

: Note; “No” will always apply to a request to
change conditions of a rezoning approval given

“under the P&E Act.

 

26.

en previous application involve concurrence agencies or building referral agencies?
NO

(21 YES - fist the concurrence egencies who have been sent @ copy of the request for modification
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