Change application form

CI Coordinates of premises by longitude and latitude

Longitude(s) Latitude(s) Datum Local Government Area(s) (if applicable)
‘| Fy wese4
| (0 GDA94
| OO Other: [a
[O Coordinates of premises by easting and northing
| Easting(s) Northing(s) | Zone Ref. | Datum Local Government Area(s) (if applicable)
| O54 CO wess4
O55 0 cpa
| (156 0 Other:

 

 

 

 

 

 

 

 

 

       

3.3) Additional premises

C Additional premises are relevant to the original development approval and the details of these premises have
been attached in a schedule to this application
LC Not required

 

 

PART 3 — RESPONSIBLE ENTITY DETAILS

4) Identify the responsible entity that will be assessing this change application
Note: see section 78(3) of the Planning Act 2016

 

 

PART 4 — CHANGE DETAILS

   
 
  

  

5) Provide details of the existing development approval subject to this change application

Approval type Reference number Date issued Assessment
manager/approval entity

[Development permit 2009 634 21.0% - 2004 <n 3h} ne
C Preliminary approval be, \ as

(J Development permit 139002..22.012S

(1 Preliminary approval

 

 

 

 

 

 

 

6) Type of change proposed

6.1) Provide a brief description of the changes proposed to the development approval (e.g. changing.a development
yee Ce ACM MA AA a ec Ae [Memeo aa ee eee

Enclose @rrortr
6.2) What type of change does this application propose?

[UMinor change application — proceed to Part 5
(CJ Other change application — proceed to Part 6

 

 

 

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Planning Act Farm 5 - Change application form
Version 1.2 — 7 February 2020