20151006144945921 · MCU14/0082.01

  
   

4. Location of the premises

Unit No. Street No Street WALLOAA LANE
Suburb Noosa State QeD

Lot no. Plan type & plan no.

Let IT sP 239726 7

  
     

  
 

 

 

  

Postcode 456

     

 

  

 

 

 

 

 

 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval? }LNo
O Yes-provide details below

Note — Under $372 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 | 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?
PANo | O Yes

If yes, please attach a copy of the notice.

 

 

7. Owner’s consent

Is the owner's consent required for this request? |O No
id 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 aaa = Owner's name/s JUN IT WV AN eR
We, the above-mentioned owner/s of the land, consent pAThe owner's written consent is attached.

 

 

to the making of this request.

 

 

Signature/s

 

Date

 

 

 

 

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