Noosa Request to Change Form

| @ | 5 = Request to Change Existing Approval and/or
mom NOOSA COUNCIL Extension to Relevant Reticd

Sustainable Planning Act 2009

This form must be submitted to Council accompanied by the applicable fee.
Attach extra pages if there is insufficient space on the form.
Please note that for development approvals that include water and sewerage conditions, a Unitywater fee may also apply.

 

1. Details of person making the request

Full name — Empirica Developments Pty Ltd c/- DFS Group
Contact Name - Peter Folker

Postal address — PO Box 605

Suburb ~ Maroochydore State - Qld Postcode — 4558
Business phone — 5443 5566 A/H phone Mobile
Email address — [email protected] Fax

 

2. Details of existing approval

Type of approval (please tick ALL applicable categories) Which entity issued approval?

X Development Permit X Council

Ol Preliminary Approval QO Other entity — please specify

O Compliance Permit

X Material Change of Use

O Reconfiguring a Lot

X Operational Works

O Building Works

O Plumbing or Drainage Works

O Compliance Certificate

O Environmentally Relevant Activity

Application number/council reference Change to an Exisitng Approval Notice Date issued 28.09.15 (first
MCU14/0102 & OPW15/0051 changed approval)

Is the approval for a mobile and temporary ERA? X No O Yes — complete below

Insert the name of each local government area in which the mobile and temporary ERA is proposed to operate/operating

3. Nature of request (please tick ALL applicable categories)

X  Tochange the development X To change the development O To extend the relevant period
approval conditions before lapsing

Please attach documentation outlining the detail of and the reasons and justification for the requested change or
extension.

Privacy

Council will use any personal information provided for the intended purpose only and for remaining in contact with you. Council is authorised to collect
this information in accordance with the Local Goverment Act 2009 and other Local Government Acts. Your personal information is only accessed by
persons authorised to do so. Your personal information is dealt with in accordance with council's privacy policy.

www.noosa.qlid.gov.au [email protected] T 07 5329 6500
PO Box 141 Tewantin Qld 4565 ABN 97 969 214 121

Page 1 of 3