05/1189 - Change to Development Approval [As Published] · 132005.1189.03

INTEGRATED PLANNING ACT 1997

3(b) Can the address be further described by shop/tenancy number or storey/evel?

 

 

No (1 Yes~ Complete Table C .
Table C Shop/tenancy number Storey/level
1.

 

 

 

 

 

Form 2, Version 4.1, 3 March 2008

4. Can the premises best be identified by coordinates (e.g. for development proposed in waters, or on a site within a large rural tol)?

 

 

No ’ [1 Yes-Compiete TableD +
Table D
Coordinates 2
. . ‘one: Local government area
(Nota: place each set of coordinales na separate row) : Reference Datum (it applicable)
Easting Northing Latitude Longitude

 

 

 

 

 

 

(7 Other

 

 

Ci cpa94 (1 wese4

 

 

5. What is the total area that makes up the premises (ie. the area covered by the application)?

 

Area of land above high water mark/outside watercourse

Area in a water body or watercourse

 

 

 

Cm — D)hectares (rick appiicable unit

 

 

Cm

CJ hectares (Tick applicable unit

 

Owner's consent and resource owner's agreement

6. aR person making the request the owner of the land to which the approval attaches?

Yes No - Complete Table E - provide details for each owner on a separate row, ar on an attachment to this form if applicable. Note: Advice
provided at the end of this farm details when owner's consent is not required.

 

Table E
Owner's name/s and postal address

Detaits of the premises owned
{Street address or lot on plan description)

Signature*

Date consent
was obtained

 

 

 

 

 

 

 

7. If an application for the existing approval were being made now (i.e. at the time of making this request), would evidence be required to
support the application because it involved taking or interfering with a State-owned resource prescribed by schedule 10 of the
integrated Planning Regulation 1998 (IP Reg) or any other regulation

No DD Yes- Complete Table F and submit, with the application, written agreement to the request.

 

Table F Nature of State-owned resource

Relevant State Government Department

Date written agreement of the chief
executive was obtained

 

 

 

| *

Nature of the request

8. What is the nature of the request for change? (Tick the applicable boxes)
1 _ Anextension of the period before an approval lapses (under IPA, section 3.5.22)
wy To change the development approval other than a change of condition (under IPA, section 3.5.24)
© To change or cancel a condition of approval (under IPA, section 3.5.33) - Go to Q11
(1 To change conditions of a rezoning approval given under the Local Government (Planning and Environment) Act 1990 (under IPA,

section 6.1.35A) - Go to Q12

9. Were one or more concurrence agencies involved in the approval?

 

 

* Owners signature can not be provided an the form if you intend to submit the application electronically. Owner's consent must be provided to the assessment manager on
an attachment containing appropriate written documentation of the owner's consent. If the owner is a company the company must sign as owner. $127 of the
Corporations Act 2001 (Cwealth) details how a company may execute a document.

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