NSC Form Stage 2_001

 

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

O To change the development O To change the development ( To extend the relevant period
approval conditions before 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. StreetNo 36 Street BEACH ROAD
Suburb NOOSA NoRTY SyoRe | State LD Postcode +S6S
Lot no. Plan type & plan no.

z= SP 18616?

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval? O No
WW Yes-provide details below

Note — Under $372 of the Sustainable Planning Act 2009 the person making the request is required to give a copy of this request to all
concurrence agencies.

DEPARTMENT CF NATURL RESOURCES WO WATER AT DANE OF LoDséMe&eT TO
Q@eUNcie

6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
WNo O Yes

If yes, please attach a copy of the notice.

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

WYes- 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

NIT HOLDINGS PIF UTD

Owner's name/s i Owner's name/s

: We, the above-mentioned owner/s of the land, consent © The owner's written consent is attached.
ito the making of this request.

: Signature/s

Date

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