Noosa Council Changes

Change application form

Planning Act Form 5 (version 1.1 effective 22 JUNE 2018) made under Section 282 of the Planning Act 2016.
This form is to be used for a change application made under section 78 of the Planning Act 2016. tt is important
when making a change application to be aware of whether the application is for a minor change that will be
assessed under section 81 of the Planning Act 2016 or for an ‘other’ change that will be assessed under section 82
of the Planning Act 2016

An applicant must complete all parts of this form, and provide any supporting information that the form identifies as
being required to accompany the change application, unless stated otherwise, Additional pages may be attached if
there Is insufficient space on the form to complete any part

Note: Al terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the
Development Assessment Rules (DA Rules).

PART 1 — APPLICANT DETAILS

     
 

 
  

S$) Uingividwal or o full navn)
Contact name (only appiicable for companies)

 
    
  

 

  

Postal address (P 0. Box or street! address)
Suburb
State
Postcode |
Country j I 4

Email address (non-mandatory) rp bine bale be '
Mobile number (oon-mandatory) — lo 4i4 i4iac

Applicant's reference number(s) (if appicame) ma

 

  

 

  
  
 

 

 

 

[4] No

 

 

PART 2 — LOCATION DETAILS

+j Street address AND lot on plan (ail iots must be tisted), OF
Street address AND lot on plan for an adjoining or adjacent property of the premises appropriate for development in
water but or to ail jots must be sted).
Unit No. Street No. Street Name and Typ: Suburb _
iA S MUSA VAT hl : c
) [Postcode | Lat No. Plan Type and Number jeg RP. SP) Local Government Area(s)
457.2% <=} ‘ 2 t La

Unit No. “Street No Street Name and T: Suburb

>) Postcode Lot No. Pian Type and Number (e.g. RP. SP) Local Government

Coordinates of and latitude
Longitude(s) | Latitude(s) Datum Local Government Area(s) it
wGsad4
GDAS4
Other:

 

Coordinates of premises by easting and norhing

Queensland
Government