Request change to an approval 152004.240078.4

                                                                                                                                 To change the development                                                                                   To extend the relevant period
                 approval                                                                                                         conditions                                                                                                 before lapsing
                                                                                                    .
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,
     Please attach documentation outlining the detail of and the reasons and justification for the requested change or

,
  extension.
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                                                                                                                  ______,_._                                  .______._..______,..___                     _..


                         ......_.._    .   ..,.......   ____________._’...._..__.._____.._._._..,_,.__._.__ ._____




     4. Location of the premises



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     Lot no.                                                                      Plan type & plan no.
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     5. Concurrence Agencies

: Was there one or more concurrence agencies involved in the original approval?
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    7. Owner’s consent

:Is the owner’s consent required for this request?                                                                                                                  !0No                                                                                                                                                             !



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    Table A                   -
                                      owner’s consent provided on form                                                                                                                Table B            -
                                                                                                                                                                                                                owner’s consent provided on form
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!Owner’s name/s 1...::l..9.~...~~~~_....~!.~.~.4~_t::__c i
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                                                                                                                                                                                  :   0The owner’s written consent is attached.                                                                                                   j
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                                                                                                                                                                                  I__...--- ._._.___._____________~..______.

I to the making of this request.

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  i~ate_.      ; L        (~2                                                                     o


    20f4                                                      2012/13 Regional Strategy and Planning Request to Change Existing Approval and/or Extension to Relevant Period FM3002s