Noosa Request to Change Form

4. Location of the premises

Unit No. Street No 139 Street Eumundi Noosa Road

Suburb Noosaville State Qld Postcode 4566
Unit No. Street No 30 Street Lionel Donovan Drive

Suburb Noosaville State Qld Postcode 4566
4 SP159610

31 1 SP170751

 

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.

Concurrence Agency Date copy given

 

 

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 O Yes

If yes, please attach a copy of the notice.

remem aret Ling

Is the owner's consent required for this request? ONo
X Yes— complete either Table A or Table B below

 

Note ~ If more than one owner of the land all owners’ details are required

BE lw wee Ta meet cela Celiit Table B — owner’s consent provided on form

Refer to attached correspondence
Owner's name/s Owner's name/s

IWe, the above-mentioned owner/s of the land, consent O The owner’s written consent is attached.
to the making of this request.

Signature/s

Date

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