DA Form 5

 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
 Noosa Shire Council

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
                                                                                             Noosa Shire Council
    Preliminary approval
    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):
Extension to Multiple Dwelling (Patio on Unit 5)
 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