102995-10 Permissible change request

 
 

4. Location of the premises

Unit No. StreetNo } 7 $ Steet Euarnund, Noose Koad
Suburb AJoasecur/le. State QLD Postcode 4S GG

Lot no. _Plan type CAC ume

10/ SP o4/37/

 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval? ONo

O Yes-provide details below

Note — Under s372 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?
{No O Yes
If yes, please attach a copy of the notice.

ON memere Tea

 

Is the owner's consent required for this request? O No

aVes- 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

   

el = ae erg Pedece Reka

: 5 Le
Owner's name/s Owner's name/s Bonn mae Praoert ee by
We, the above-mentioned owner/s of the land, consent die owner's written consent is attached.

to the making of this request.

Signature/s

Date

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