Request Change to Development Approval (17107 DA) 1399.982748.01

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                                                                           o      To change the development                                o             To extend the relevant period
                                                                                  conditions                                                             berore lapsing
    Please attach documentation outlining the detail of and ttle reasons and justification for the requested change or
    extension.




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    6. Pre-request response notice

~sa pre-~~~~~_!!~PO~~~_~~.!~J1.I~~~ ?t_a relevant entity (e.g.a cpncu_r~~.~?~..a~~n?y) for this reque~t?...__.
!e’No                                                                                            10 Yes
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Ilfyes. please atta~~~~opy of the notice~.                                        ....   """"’" __._   ______________.......                      __    ,     ... .....    ...______...
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                                                                                                                                    either Table A or Tabla B below                                             ’




~ot~:::.~~_Il_1~.r~.~~.~_~~.~~,~.~.~fthe                        land all owners’ details are requl~:~
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    Owner’s name/s
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,   I/We, the above-mentioned ownerls of the land, consent
:to the

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          making of this request.
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                                                                                                           Owner’s name/s
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                                                                                                           o The owner’s written consent is attached.
i_Slgnature/s                       ’._::(9?/{J                              ~j

    2 of 4         2011/12 Regional Strategy and Planning Request to Change Existing Approval and/or Extension to Relevant Period FM401