3461ChangesApplication · MCU14/0060

4. Location of the premises

 

 

 

Unit No. StreetNo JS Street HOoCTs ROAA
Suburb - <ooR0 y — Stae Qcs Postcode 4£63
“RP 85 33989

 

 

   

 

 

 

 

5. Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval?
Oo Ye oa ‘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” O Yes
If yes, please attach a copy of the notice.

7. Owner’s consent

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

SoH MORROW
GLEVBRAL OPELATIOM! rz eT

IWe, the above-mentioned owner/s of the land, consent The owner's written consent is attached.
to the making of this request.

 

 

 

 

 

 

 

 

 

 

   

 

 

 

Owner’s name/s Owner's name/s

Signature/s

Date

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