Planning Act Form 5-Change application form · 132008.176.06

 3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or adjacent to land
      e.g. channel dredging in Moreton Bay)
 Note: Place each set of coordinates in a separate row.
    Coordinates of premises by longitude and latitude
 Longitude(s)                    Latitude(s)                    Datum                           Local Government Area(s) (if applicable)
                                                                    WGS84
                                                                    GDA94
                                                                    Other:
    Coordinates of premises by easting and northing
 Easting(s)              Northing(s)              Zone Ref.     Datum                           Local Government Area(s) (if applicable)
                                                      54            WGS84
                                                      55            GDA94
                                                      56            Other:
 3.3) Additional premises
    Additional premises are relevant to the original development approval and the details of these premises have
    been attached in a schedule to this application
    Not required

PART 3 – RESPONSIBLE ENTITY DETAILS

 4) Identify the responsible entity that will be assessing this change application
 Note: see section 78(3) of the Planning Act 2016
 State Assessment and Referral Agency (SARA)

PART 4 – CHANGE DETAILS
 5) Provide details of the existing development approval subject to this change application
 Approval type                       Reference number                   Date issued                         Assessment
                                                                                                            manager/approval entity
    Development permit               2210-31715 SRA                     26 October 2023                     SARA
    Preliminary approval             (132008.176.05)                    (24 October 2025)                   (Noosa Shire Council)
    Development permit
    Preliminary approval

 6) Type of change proposed
 6.1) Provide a brief description of the changes proposed to the development approval (e.g. changing a development
     approval for a five unit apartment building to provide for a six unit apartment building):

 Change to referral agency response conditions 1, 2, 7, 8 & 9 – refer attached correspondence

 6.2) What type of change does this application propose?
    Minor change application – proceed to Part 5
    Other change application – proceed to Part 6




                                                                                                                                        Page 2
                                                                                                  Planning Act Form 5 - Change application form
                                                                                                                 Version 1.2 — 7 February 2020