Planning Act Form 5 - Change application form · 51989.1272.03

     Postcode                     Lot No.                                Plan Type and Number (e.g.               Local Government
                                                                         RP, SP)                                  Area(s)


3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or adjacent to land e.g.
     channel dredging in Moreton Bay)
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        Datum                 Local Government Area(s)
                                                                              Ref.                              (if applicable)

                                                                                              WGS84
                                                                                  54
                                                                                              GDA94
                                                                                  55
                                                                                  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
                                     5198.1272                          1989
    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):

 Proposed alterations and additions to existing dwelling

 6.2) What type of change does this application propose?
    Minor change application – proceed to Part 5



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                                                                                                   Planning Act Form 5 - Change application form
                                                                                                                  Version 1.2 — 7 February 2020