Request to change the development approval 132006.674.01

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    !i1(   To change the development            0    To change the development                   0   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.




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    6. Pre-request response notice

I Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
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IONO                                                    IDYe~                                             ----I
i_~f.J!.!!.E!ease a~~~_a copy_~~he noti~.:.:_______________________________________________________________________.1

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    Is the owner’s consent required for this request?




    Table A   - owner’s consent provided on form                              Table B   -
                                                                                            owner’s consent provided on form
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                                                                          i
j Owner’s name/s
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                                                                          I Owner’s name/s
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j-----                -------------------------"’1                                           .___~.____.____.___._______._.




!I/We, the above-mentioned ownerls of the land, consent i                 i 0The owner’s written consent is attached.
! to the making of this request.                                  :


i Signature/s
i
:Date




    2 of 4            2012/13 Regional Strategy and Planning Request to Change Existing Approval andlor Extension to Relevant Period FM3002s