102995-10 Permissible change request

  

w ebNeles eeeencens eu ee

Sustainable Planning Act 2009

This form must be submitted to Council accompanied by the applicable fee.
Attach extra pages if there is insufficient space on the form.
Please note that for development approvals that include water and sewerage conditions, a Unitywater fee may also apply.

1. Details of person making the eo

Full name — individual or company wy Ppete ¢ Pty +o c/- Res

Contact Name — for company Le [Foun 5

Postal address RP Box 15S?
Suburb fo, -hircle vedlery State QLD Postcode Y“OO6
Business phone Z/L.Y IFRS 7 AJH phone Mobile

Email address So ohie ue //\ Maras pe Percept Con. af

2. Details of existing approval

 

Type-of approval (please tick ALL applicable categories) Which entity issued approval?
Development Permit O Council

O Preliminary Approval O Other entity — please specify

O Compliance Permit
Material Change of Use

& Reconfiguring a Lot

Operational Works

Building Works

Plumbing or Drainage Works

Compliance Certificate

oooada

Environmentally Relevant Activity

Application number/council reference Date issued

Is the approval for a mobile and temporary ERA? O No O Yes — complete below
Insert the name of each local government area in which the mobile and temporary ERA is proposed to operate/operating

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

Ol To change the development M Tochange the development Ol To extend the relevant period
approval conditions before lapsing

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

 

Privacy

Council will use any personal information provided for the intended purpose only and for remaining in contact with you. Council is authorised to collect
this information in accordance with the Local Government Act 2009 and other Local Government Acts. Your personal information is only accessed by
persons authorised to do so. Your personal information is dealt with in accordance with council’s privacy policy

www.noosa.qid.gov.au [email protected] T 07 5329 6500
PO Box 141 Tewantin Qld 4565 ABN 97 969 214 121

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