Appendix A - Form 5

 3.2) Coordinates Of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or adjacent to land
      e.g. channel dredging in Moreton Bay)
 Note: Place each set of coordinates in a separate row.
 □ Coordinates of premises by longitude and latitude
 Longitude(s)                   Latitude(s)                     Datum                           Local Government Area(s) (if applicable)
                                                                □ WGS84
                                                                □ GDA94
                                                                □ Other:
 □ Coordinates of premises by easting and northing
 Easting(s)             Northing(s)              Zone Ref.      Datum                           Local Government Area(s) (if applicable)
                                                 □ 54           □ WGS84
                                                 □ 55           □ GDA94
                                                 □ 56           □ Other: |

 3.3) Additional premises
 □ Additional premises are relevant to the original development approval and the details of these premises have
   been attached in a schedule to this application
   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
 Noosa Shire Council



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                                                                                       Noosa Shire Council
                                    MCU16/0090                          19/12/2016
 □ Preliminary approval
 □ Development permit
 □ 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
    approval for a five unit apartment building to provide for a six unit apartment building):
 Please refer to the attached covering letter dated 15 February 2023


6.2) What type of change does this application propose?
  Minor change application - proceed to Part 5
□ Other change application - proceed to Part 6




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