132002.220611.5 Extension of relevant period - 14 Serenity Cl, Noosa Heads

                                                                                                                                                     .   .


    4. Location of the premises
    Unit No.                      Street No      1~__          1   Street     se.f£NIN              C.LDSE.                                                  I
    Suburb       f()OOSA                                                          , State   QL2:>                          I-Po-s-tc-od-e-l.;S~b7~

    Lot no.                       Plan type & plan no.
I                  1.-0"1 ~                             I




    5. Concurrence     Agencies
    Was there one or more concurrence agencies involved in the original approval?                        '0 No
                                                                           1------------1
                                                                           o Yes-provide details below
                                                     -;=:c=-=~~~~....".~~~~'"'C"'"--:.,.-
    Note - Under 5372 of the Sustainable Planning Act 2009 the person makingthe request is required to give a copy of this request to all
    concurrence agencies.
    Concurrence      Agency                                                                              Date copy given




~===================--
    6. Pre-request   response     notice
                                                                                                         --------------

     a       pre-request response been given by a relevant entity (e.g, a concurrence agency) for this request?
I---c      ---                                                                                           --------------,
    ~ No                                                              0 Yes
    If yes, please attach a copy of the notice.




    Is the owner's consent required for this request?
                                                                            o 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 namels      L _
    l/lNe, the above-mentioned ownerls of the land, consent
                                                                                Owner's namels       I
                                                                                o The owner's written consent is attached.
    to the making of this request.

    Signaturels


    Date




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