OPW12.0139.01 Application to change existing approval - forms & plans · OPW12/0139

3. Nature of request (please tick ALL applicable categories)

O To change the development xO To change the development QO To extend the relevant period
approval conditions before lapsing

Please of outlining the detail of and the reasons and justification for the requested change or
extension.

4. Location of the premises
Unit No. StreetNo 4&6 Street GYMPIE IL RRACE

Suburb Noosk VIVE State QLD Postcode
Plan type & plan no.

Lot 42 cP 407407

   

SEG

       

  
 

5. Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval? O No
Pa¥es-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 ret Date copy given
DEPK 1tA~SPo4 Min 2oAAS oS [o3| i@
pe Pt oF Af Mae 4 HER {AGE (LECTic wy os |o3 id

i)

6. Pre-request response notice
Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?

ee — Bvt WAS Bee) CFaVESTED Dyes
f

yes, please attach a copy of the notice.

ee meet
Is the owner's consent required for this request? ee
Y

es— 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

|

IWe, the above-mentioned owner/s of the land, consent O The owner's written consent is attached.
to the making of this request.

Signature/s

Date

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