Request Form · 132008.176

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

    To change the development                
    To change the development               X To extend the relevant period before
     approval                                      conditions                              lapsing
Please attach documentation outlining the detail of and the reasons and justification for the requested change or
extension.


4. Location of the premises
Unit No.                      Street No - 3                 Street - Serenity Close
Suburb – Noosa Heads                                                         State - QLD                 Postcode - 4567
Lot no.                       Plan type & plan no.
10                            SP195871
11                            SP195871




5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval?                 
 No
                                                                                              X Yes-provide 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
DILGP - SARA
- DNRM – Assessable Vegetation                                                                04/01/2017
- DEHP – Koala Conservation                                                                   04/01/2017


6. Pre-request response notice
Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
x No                                                       
 Yes
If yes, please attach a copy of the notice.


7. Owner’s consent
Is the owner’s consent required for this request?                  x 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

Owner’s name/s                                                            Owner’s name/s

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

Signature/s


Date




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