Change to Existing Approval - OPW11/0116.01

     DDD

 Table C-premises coordinates (appropriat.e fOT development in remote areas, over part of a lot or in water e.g. channel
 dredging in Moreton Bay)

 Coordinates                                                          lone          Datum             Local government
 (note:place each set of coordinates in a separate row)               refer’ence                      area (if   applicable)
 Easting           Northing       Latitude            Longitude


                                                                                    D GDA94
                                                                                    D WGS84
                                                                                    D Other


15. Details of the proposed change
           of/ached.
IA5
 6. Is owner’s consent required for this request? (refer to notes at the end of this form for more information)



 ~ No
 o Yes-complete either table D      or table E as   applicable


 Table D


 Name of owner of the land


 I, the above.mentioned owner of the land, consent to the making of this request.

 Signature of owner of the land



 Date



 Table E

 Name of owner of the land
                                         I
 D The owner’s written consent is attached




               3                                                        Request to change an existing approval template
                                                                                                Version 1 1 March 2010