Signed Request to Change Existing Approval

4. Location of the premises

Unit No.

| Street No: 70

| Street: Carpenters Lane

 

 

   

Ci

Suburb: Cooroy
ee

SP248288

| State: QLD

  

| Postcode: 4565

 

 

$P242414

 

 

 

 

5, Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval? X No

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. : cae ;

ence Agen Ee Lo
State Assessment and Referral Agency (SARA QLD NORTH)

 

 

  
 
 

     

toe My ;
12 November 2014

 

 

 

6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?

 

 

 

 

 

 

X No [Yes

If yes, please attach a copy of the notice.

mee Teme

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

 

 

O Yes— complete either Table A or Table B below
Note — If more than one owner of the land all owners’ details are required

 

    

Owner's name/s

 

 

enna | Owner's name/s

 

We, the above-mentioned owner/s of the land, consent
to the making of this request.

 

O The owner's written consent is attached.

 

 

Signature/s

Date

 

 

 

 

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