Changes Application - MCU15/0023.02

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3. Nature of request (please tick ALL applicable            categories)
~      To change the development                  0    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.


4. Location    of the premises
Unit No.                         Street No        t+          Street        S5f>1VlEVv          TeRRPlG~
Suburb        QIN c;}-\ ,,,, ~    11~f\{.11                                      State      <3l-\..U               Postcode   4-Sn
Lot no.                          Plan type & plan no.




5. Concurrence       Agencies
Was there one or more concurrence agencies involved in the original approval?                          l8'"No
                                                                                                       o 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.
Concurrence       Agency                                                                               I Date copy given




6. Pre-request     response      notice
Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
o No                                                             10 Yes
If yes, please attach a copy of the notice.


7. Owner's consent
Is the owner's consent required for this request?                      e:D::...:.N.:.:o=-                                                     j
                                                                       o Yes- complete either Table A or Table B below
Note -If   more than one owner of the land all owners' details are required


Table A - owner's consent           provided on form                         Table B - owner's consent provided on form

Owner's name/s                                                                Owner's name/s

IflNe, the above-mentioned ownerls of the land, consent                      )I!t The owner's written consent is attached.
to the making of this request.

Signature/s


Date




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