DA Form 5 · 132001.210331.6

Page 2

LJ Coordinates of premises by longitude and latitude

 

 

Longitude(s) Latitude(s) Datum Local Government Area(s) (if applicable)
PY C0 wese4
C1 Gpag4
OJ Other:

 

 

C1 Coordinates of premises by easting and northing

 

 

Easting(s) Northing(s) Zone Ref. | Datum Local Government Area(s) (if applicable)
054 LJ weses4
(155 CL] Gpag4

 

 

   

 

 

 

0156 CO Other:

       
     

3.3) Additional premises
C1 Agditional premises are relevant to the original development approval and the details of these premises have
een attached in a schedule to this application
Not required

 

 

 

PART 3 —- RESPONSIBLE ENTITY DETAILS

OMe Tal Vm alt -tyofelal1o) en Wma Bec e-SottgeR aTS change application
Note: see section 78(3) of the Planning Act 2016

Noosa CoINIC\—

 

 

PART 4 — CHANGE DETAILS

    
    

2)
Approval type Reference number

   

Provide details of the existing development approval subject to this change application

    

Date issued Assessment

manager/approval entity
[ff Development permit SUNSHINE

REGrovred
CI Preliminary approval 22, A+ \ DA, infor 103 rey earl «

( Development permit
C Preliminary approval

       

f.

 

 

 

 

 

 

 

 

     
 

6) Type of change proposed

6.1) Provide a brief description of the changes proposed to the development approval (e g. changing a development
Cool elm MUA ME ora caged eam CM geL (eR eee aaa Flohr are elae)

Removal OF TREE_ KNOWN AS “TREE 39"

6.2) What type of change does this application propose?

 

 
   
   
     

  

[VI Minor change application — proceed to Part 5
Cd Other change application — proceed to Part 6

  

 

Page 2
Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020

Page 3

PART 5 — MINOR CHANGE APPLICATION REQUIREMENTS

7) Are there any affected entities for this change application

 

re — 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 pre-
request response notice for the application has been request response provided)
given, a copy of the notice must accompany this change
application)

 

EINo

U1 Yes ~ pre-request response is attached to
PFRSESTMENT MAN iat this change application
C1No

O Yes - pre-request response is attached to
this change application

[No

0 Yes - pre-request response is attached to
this change application

 

 

 

 

 

 

 

PART 6 —- OTHER CHANGE APPLICATION REQUIREMENTS

Note: To complete this part it will be necessary for you to complete parts of DA Form 1 — Development application details and in some instances parts
of DA Form 2 — Building work details, as mentioned below. These forms are available at https://planning. dsdmip.qid.gov.au.

8) Location details - Are there any additional premises included in this change application that were not part of the
original development approval?

 

 

9) Development details

9.1) Is there any change to the type of development, approval type, or level of assessment in this enn
application?
LCINo
C1 Yes ~ the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 — Development application
details as these sections relate to the new or changed aspects of development are provided with this application.

9.2) Does the change application involve building work?

LNo

CO Yes - the completed Part 5 (Building work details) of DA Form 2 — Building work details as it relates to the
change application is provided with this application.

  

 

 

10) Referral details - Does the change application require referral for any referral requirements?

Note: The application must be referred to each referral agency triggered by the change application as if the change application was the original
Nelo dara) oy ee lelg Male Ue aeR proposed change.

LC No
0 Yes - the completed Part 5 (Referral details) of DA Form 1 — Development application details as it relates to the
change application is provided with this application. Where referral is required for matters relating to building
work the Referral checklist for building work is also completed.

 

 

 
 
 

11) Information request under Part 3 of the DA Rules

[1 | agree to receive an information request if determined necessary for this change application

[1 | do not agree to accept an information request for this change application
Note: By not agreeing to accept an information request I, the applicant, acknowledge:

 

 

 

Page 3
Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020

Page 4

 

* that this change application will be assessed and decided based on the information provided when making this change application and the
assessment manager and any referral agencies relevant to the change application are not obligated under the DA Rules to accept any
additional information provided by the applicant for the change application unless agreed to by the relevant parties

* Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.
Further advice about information requests is contained in the DA Forms Guide: Forms 1 and 2.

 

 

12) Further details

C Part 7 of DA Form 1 — Development application details is completed as if the change application was a
development application and is provided with this application.

 

 

 

PART 7 — CHECKLIST AND APPLICANT DECLARATION

13) Change application checklist
| have identified the:

* responsible entity in 4); and dh
* for a minor change, any affected entities; and Yes
¢ for an other change all relevant referral requirement(s) in 10)

Note: See the Planning Regulation 2017 for referral requirements

    

 

 

For an other change application, the relevant sections of DA Form 1 — Development O Yes
application details have been completed and is attached to this application C Not applicable
For an other change application, where building work is associated with the change Oyes

 

application, the relevant sections of DA Form. 2 — Buil
completed and is attached to this application

Supporting information addressing any applicable assessment benchmarks is attached to

iding work details have been (Not applicable

 

this application

Note: This includes any templates provided under 23.6 and 23.7 of DA Form 1 — Development application details Yes
that are relevant as a result of the change application, a planning report and any technical reports required by the PREV ious PRon den
relevant categorising instrument(s) (e.g. the local government planning scheme, State Planning Policy, State ‘

Development Assessment Provisions). For further information, see DA Forms Guide: Planning report template. emo UON NOR NBuWe

Relevant plans of the development are attached to this development application

Note: Relevant plans are required to be submitted for all relevant aspects of this change application. For further O Yes
information, see DA Forms Guide: Relevant plans.

 

 

 

   

14) Applicant declaration

LW By making this change application, | declare that all information in this change application is true and correct.

[M Where an email address is provided in Part 1 of this form, | consent to receive future electronic communications
from the responsible entity and any relevant affected entity or referral agency for the change application where
written information is required or permitted pursuant to sections 11 and 12 of the Electronic Transactions
Act 2001.

Note: It is unlawful to intentionally provide false or misleading information.

Privacy — Personal information collected in this form will be used by the responsible entity and/or chosen

assessment manager, any relevant affected entity or referral agency and/or building certifier (including any

professional advisers which may be engaged by those entities) while processing, assessing and deciding the
change application.

All information relating to this change application may be available for inspection and purchase, and/or published on

the assessment manager’s and/or referral agency’s website.

Personal information will not be disclosed for a Purpose unrelated to the Planning Act 2016, Planning Regulation

2017 and the DA Rules except where:

* such disclosure is in accordance with the provisions about public access to documents contained in the
Planning Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016
and Planning Regulation 2017; or

° required by other legislation (including the Right to Information Act 2009); or

* — otherwise required by law.
This information may be stored in relevant databases. The information collected will be retained as required by the
Public Records Act 2002.

   

 

 

 

 

Page 4
Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020

Page 5

PART 8 - FOR COMPLETION OF THE ASSESSMENT MANAGER — FOR OFFICE

USE ONLY

 

Date received: LY Reference number(s): [

Description of the work

 

 

QLeave project number

 

Amount paid ($)

Date paid (dd/mm/yy)

 

Date receipted form sighted by assessment manager

 

Name of officer who sighted the form

 

 

 

 

Page 5

Planning Act Form 5 - Change application form

Version 1.2 — 7 February 2020

Page 6

LAND TITLE ACT 1994

REGISTRATION CONFIRMATION STATEMENT

NATURAL RESOURCES, MINES AND ENERGY, QUEENSLAND
Title Reference : 16847097
This is the current status of the title as at 07:00 on 14/07/2020
REGISTERED OWNER
Dealing No: 720145812 09/07/2020

WOOLLEY HOLDINGS GROUP PTY LTD A.C.N. 130 323 036

ESTATE AND LAND
Estate in Fee Simple

LOT 55 REGISTERED PLAN 52918
Local Government: NOOSA

EASEMENTS, ENCUMBRANCES AND INTERESTS

1. Rights and interests reserved to the Crown by
Deed of Grant No. 10627160 (ALLOT 2 SEC 11
Deed of Grant No. 10802241 (ALLOT 12 SEC 11
Deed of Grant No. 10804108 (ALLOT 3 SEC 11

2. EASEMENT No 601223388 (G547987) 28/10/1981
BENEFITING THE LAND
OVER EASEMENT A ON RP177551

3. EASEMENT No 601223389 (K753986V) 29/08/1991
BENEFITING THE LAND
OVER EASEMENT A ON RP177551

4. EASEMENT No 601031936 (L973305R) 24/05/1994 at 09:08
benefiting the land over
EASEMENT A ON RP 177551

5. MORTGAGE No 713499733 05/10/2010 at 12:36
NATIONAL AUSTRALIA BANK LIMITED A.B.N. 12 004 044 937

ADMINISTRATIVE ADVICES - NIL
UNREGISTERED DEALINGS - NIL

DEALINGS REGISTERED
720145812 CHANGE NAME FLA/87338

Caution - Charges do not necessarily appear in order of priority
** End of Confirmation Statement **

EV Dann
Registrar of Titles and Registrar of Water Allocations

Page 1/2