Pre_Request_Response_Form NSC · 131999.982963.6

 4. Location of the premises
 Unit No.                   Street No 20              Street Bayview Road
 Suburb Noosa Heads                                                 State Qld                   Postcode 4567
 Lot no.                    Plan type & plan no.
Originally (1) Lot 1 &      Originally (1) RP136508 & (2) GTP103170
(2) Lots 1 and 2
 Currently Lot 5            SP174659




 5. Declaration of applicant
 I/We, the applicant, declare that the above information is correct in all respects, at the time of lodgement of this
 application with Council. Should any of the details given in relation to this application be changed in the future, the
 applicant shall advise Council in writing prior to any such change being implemented.
 Signature                                                                               Date


 OFFICE USE ONLY
 Application no.     Amount paid      Date paid          Receipt no.        Initial             Date stamp


 Receiving Officer




 Payment options

 In Person    9 Pelican Street, Tewantin: 8.30 am to 4.30 pm Monday to Friday (excludes public holidays).
 By Link      A payment link will be forward to you once your application has been lodged.
 By mail      Cheque or money order to be made payable to Noosa Council.
               Cheque                                          Money order

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