132007.1022.01 Extension to relevant period

Request to change an existing approval template
(sustainable Planning Ac/ 2009 version i.i effective March 2010)


This template may be used for giving a written notice asking the responsible entity to make a permissible change to a
development approval under section 369 of the Sustainable PlanningAct2009 (SPA). It should be noted that if the
responsible entity for the request has a form for the request, the request must made using that form.

This template must be lodged with the following entity (the responsible entity) as applicable:
•     if the change is to a condition imposed by a Minister under chapter 6, part ii, division i of SPA the template must be
      lodged with the Minister that imposed the condition
•     if the approval was given by a Minister under chapter 6, part ii, division 2 of SPA the template must be lodged with
      the Minister that gave the approval
•     if the change is to a condition of the approval imposed by a concurrence agency the template must be lodged with the
      concurrence agency
•     if the approval was given by the Planning and Environment Court the template must be lodged with the Planning and
      Environment Court
•     in all other cases the template must be lodged with the assessment manager for the original development application.

Attach extra pages if there is insufficient space on this template. Terms used in this template having the meaning given in
the Sustainable Planning Act 2009.



i. Who is making the request?

Name/s (individual or company name in full)                                  V ,As, I a         wi


For companies, contact name                                                %(' r' /c )    CCa7Si    'l fl%^Li

Postal address                                                     PO
                                                                                                      6)   4 c '0 -7
Contact phone number


Mobile number (non-mandatory)


Fax number (non-mandatory)

e-mail address (non-mandatory)                                          'K)Gt GtrtV1-e_
                                                                                          0   9-7