Attachmetn A - Council Form · MCU15/0111.01

ature of request (please tick ALL applicable eeyeleucn)
:O Tochange the development a To change the development {0 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. i

 

___ |Street No 19 /Street Trading Post Road
‘State QLD

  
  
 
 

' RP165418
| RP2t6922

   

 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval? | 0 No
i "RW Yes-provide details below

Note — Under 8372 of the Sustainable Planning ‘Act 2008 th the person making the request i is required to give a copy of this request to all
concurrence agencies.
i Sag

   

inves.

 

7. Owner's consent

is the owner's consent required for this request? lo No =
i ia Yes- complete either Table A or Table B below

 

iNote — “if more than one owner of the land all owners’ details are required —

Table A — owner's consent provided on form

Walter Elliott Holdings Pty Ltd

 

iOwner'’s name/s
Orianda Maria Toffoli 1 ‘ / / :

i ilWe, the above-mentioned owner/s of the land, consent i ‘oO The owner's written consent is attached.
‘to the making of this request.

Owner's name/s

: Signature/s :

‘Date AV) tr [A 16 |

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