132007.1022.01 Extension to relevant period

       qq
Table C-premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g. channel
dredging in Moreton Bay)

Coordinates                                                           Zone          Datum           Local government
(note: place each set of coordinates in a separate row)               reference                     area (if applicable)
Easting         Northing          Latitude          Longitude


                                                                                         G DA94
                                                                                         WGS84

                                                                                     q   Other




5. Details of the proposed change


                                                                                   1`v 3 et-k-
    O^ GCG^ cfL L 3t c _           1L. cx:       ^1-E'G^   5



6. Is owner's consent required for this request? (refer to notes at the end of this form for more information)

       No

I Yes-complete either table D or table E as applicable
q

Table D

Name of owner of the land                                      a,^^
I, the above-mentioned owner of the land, consent to the making of this request.

Signature of owner of the land


Date


Table E

Name of owner of the land

q The owner's written consent is attached




                                                                                              Version 1.1 March 2010