07/2555 - Change to Existing Approval - Ext of Currency [As Published] · 142007.2555.02

 

INTEGRATED PLANNING ACT 1997 Form 2, Version 4.1, 3 March 2008
3(b) IW Ne address be further described by shop/tenancy number or storey/tevel?

No [1 Yes- Complete Table C -
Table C | — Shop/tenancy number Storeyflevel

| *

4. CanJhe premises best be identified by coordinates (e.g. for development proposed in waters, or on a site within a large rural lot)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No (1 Yes - Complete Table 0
Table D
Coordinates
{Nota: place each set of coordinates in a separate row) Rene Datum Loce CO area
Easting Northing Latitude Longitude PP
1. Li cpas4 (] wese4
C Other
5. Whatis the total area that makes up the premises (i.e. the area covered by the application)?
Area of land above high water mark/outside watercourse Area in a water body or watercourse
\. 4 Om [Wfectares (Tick applicable unit) Chm? =D) hectares (Tick appticabie unit

 

 

 

 

 

 

Owner's consent and resource owner's agreement a

6. wie making the request the owner of the land to which the approval attaches?
Y

es oO No — Complete Table E - provide details for each owner on a separate row, or on an attachment to this form if applicable. Note: Advice
provided at the end of this form details when owner's consent is not required.

 

 

Date consent

Table E Details of the premises owned
was obtained

7 *
Owner's name/s and postal address {street address or fot on plan description) Signature’

 

 

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7. _ If an application for the existing approval were being made now {i.¢. at the time of making this request), wouthce be required to
support the application because it involved taking or interfering with a State-owned resource prescribed by schettuffe 10 of the
Integrated Planning Regulation 1998 (IP Reg) or any other regulation

No (1 Yes — Complete Table F and submit, with the application, written agreement to the request.

 

Date written agreement of the chief

Table F
Nature of State-owned resource Relevant State Govemment Department executive was obtained

 

 

 

 

 

 

 

Nature of the request

8. a the nature of the request for change? (Tick the applicable owes) ‘
An extension of the period before an approval lapses (under IPA, section 3.5.22)
(1 To change the development approval other than a change of condition (under IPA, section 3.5.24)
1 Tochange or cancel a condition of approval (under IPA, section 3.5.33} - Go to Q17
(1 To change conditions of a rezoning approval given under the Local Government (Planning and Environment) Act 1990 (under IPA,
section 6.1.354) - Go fo Q12

9, Were one or more concurrence agencies involved in the approval?

* Owners signature can not be provided on the form if you intend to submit the apolication electronically. Owner's consent must be provided to the assessment manager on
an attachment containing appropriate written documentation of the owner's consent. If the owner is a company the company must sign as owner. $127 of the
Corporations Act 2001 (Cwealth) details how a company may execute a document.

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