180078 - DA Form 5 · 51901.3604.01

                                                         ☑ 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 relevant to the original development approval and their details 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
JDBA Certifiers

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
                                    TPC 1057                                                              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):
Changing of development approval TPC 1057 – setbacks to the waterway, landscaping and the conditions of the
original development approval.

6.2) What type of change does this application propose?
☑ Minor change application – proceed to Part 5
☐ Other change application – proceed to Part 6

PART 5 – MINOR CHANGE APPLICATION REQUIREMENTS
7) Are there any affected entities for this change application
☑ No – proceed to Part 7
☐ Yes – list all affected entities below and proceed to Part 7
Note: section 80(1) of the Planning Act 2016 states that the person making the change application must give notice of the proposal
and the details of the change to each affected entity as identified in section 80(2) of the Planning Act 2016.
Affected entity                         Pre-request response provided? (where a pre-            Date notice given (where no
                                        request response notice for the application has         pre-request response
                                        been given, a copy of the notice must                   provided)
                                        accompany this change application)
                                        ☐ No


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                                                                                      Planning Act Form 5 - Change application form
                                                                                                      Version 1.1 — 22 JUNE 2018