ADAMS+SPARKES MCU Permissible Change Request (David Low Way) 160105 · MCU13/0251

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

Coordinates                                                   Zone         Datum           Local government
(note: place each set of coordinates in a separate row)       reference                    area (if applicable)

Easting          Northing         Latitude       Longitude


                                                                               GDA94
                                                                               WGS84
                                                                               Other



5. Details of the proposed change


Change to Condition 35 - refer to letter




6. Is owner’s consent required for this request? (refer to notes at the end of this form for more information)


 X No

       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

       The owner’s written consent is attached




Request to change existing approval template                                                                -3-