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

ITEGRIFED PLANNING FCF 1997

Form 2, Version 4.1, 3 March 2008

No 0 Yes- Comptete Table G. Submit, with the application, a copy of the notice required to be sent to each agency under

IPA sections 3.5.22(1)(a) ard 3.5.24(1)(b).

 

Each concurrence agency
Table G (use a separate row for each agency}

Date notice sent

 

1.

 

 

10. TF ee ee a aton sap othe newnaete

 

No CO Yes- Complete Table H. Submit, with the application, a copy of the notice required to be sent to each agency under
IPA section 3,5.24{1)0).
Each buitding referral agency Date notice sent
Table H (use a separate row for each agency) (native only required for request to change a
evelopment approval)

 

1,

 

 

 

 

Details and reasons or justification for the request

 

11. What are the details of the requested change and the reasons or justification for the change? Use a different row for each change if more

than one,

 

Details of requested change (nckating extension of the peniod i relevari)

Reasons or justification for the requested change

 

 

 

4) 4 2).

tl<aeae leleors altsacloo

 

See ‘ellero sttar oh

 

Mandatory attachments and information

12. What are the mandatory attachments and supporting information accompanying this application?

 

 

 

 

 

 

 

 

 

Description of attachment or information Title and date (7 appicathe) Method of defivery to assessment
(e.g. notice to concurrence /buiting referral agencies, owner's: (e.g. James Sveet Traffic Report) manager
consent, resource owner's agreemem, drawings, reports)
1. \
OFFICE USE ONLY
. 433062
Date received Reference numbers Cost Code (apaicable to EPA only) (ERAs)

 

 

 

 

 

 

 

 

 

 

Advice for completing Form 2

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