132007.1022.01 Extension to relevant period

3. Nature of request (please tick ALL applicable categories)
q     To change the development               q    To change the development               q' 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.                      Street No       o S^          Street    L; y'Vi r' i        1 C-
Suburb        1\ : O A V t u-L                                                State                       Postcode        s

                              Plan type & plan no.




5. Concurrance Agencies
 Was there one or more concurrence agencies involved in the original approval?                 0No
                                                                                               q Yes-provide details below
Note - Under s372 of the Sustainable Planning Act 2009 the person making the request is required to give a copy of this request to all
concurrence agencies.

Conc,u"j,m,         enc.y,                                                                     Date copy gi




6. Pre-request response notice
    Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?

      No                                                         q Yes
 If yes, please attach a copy of the notice.


 7. Owner's consent
 Is the owner's consent required for this request?                   q No
     1),' } t a - p ^ _ r ,^ -, % I /e-`7c                           q Yes- complete either Table A or Table B below
 Note - If more than one owner of the land all owners' details are required



 Table q       wner's;clonsen provided ob iarrn V
                                                                          Date
 Owner's name/s
                                                                          Table A -owner's consent provided on foi
 I/We, the above-mentioned owner/s of the land, consent
                                                                          Owner's name/s
 to the making of this request.

 Signature/s                                                                q The owner's written consent is attached.




 2 of 4     2011112 Regional Strategy and Planning Request to Change Existing Approval and/or Extension to Relevant Period FM401