Application Form · 131998.982104

  

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

t

| To change the development i To change the development O To extend the relevant period
_approval_ conditions _before fore lapsing

'Please attach documentation outli ng the detail of and the reasons and justification for the requested change or ,
jextension. = Se¢ S84_ FED otrss ev bec 20/6 - j

  
  

4. Location of the edges,
—___{StreetNo 52. [Street Senview |
SUNS INE hence ‘State ep ‘Postcode 456
/Plan type & plan no.

@L | RF €@G/0

   
  
 

    

 

   

| Was there one or more concurrence agencies ee in the original se ‘or No
den T fe re, 2G a2 670 Yes
| JCA ts ace OSGEEX Zs oO. Yes provide details below

' Note — Under s372 of the ee ere ite Cat 2009 eve person making the ear, is required to give a copy of this request to all
, concurrence agencies.

Concurrence Agency al? copy given

 

ry Has a pre-request re Tesponse been given t by a relevant entity (e. g. a concurrence > agency) for ‘this request? —

 

 

vee Tle) eee

| Is the owner’s consent required for this request? |

| a Ye S— complete ‘either Table Aor Table B below
‘Note — lf more than one owner of the land all Owners’ details are required

Wl A — owner's consent provided on form brant B — owner’s consent provided on form

 

| Owner's name/s | ia “Owner's name/s

Ln ae ee nn as |
\IWe, the above-mentioned owner/s of the land, consent io The owner's written consent i is attached.
to the making of this request. — i a

‘Sinatra ET

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