132009.1102.01- Request to Change to Existing Approval

3. Nature of request (please tick ALL applicable categories)
El' To change the development                 q    To change the development                q   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.


4. Location of the premises
                              Street No     3 oZ            Street     AY P ST/ rV4 S            S -7/e E 7'
              A/0 VS q-          I-rC- 6q6 S                                 State      Q                 Postcode      9-
                             I Plan type & plan no.
                                 SN /00,3660




5. Concurrance Agencies
Was there one or more concurrence agencies involved in the original approval?                   0-No
                                                                                                q 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?
E4o                                                             q Yes
If yes, please attach a copy of the notice.


7. Owner's consent
Is the owner's consent required for this request?                    q No
                                                                     Q-Yes- complete either Table A or Table B below
Note - If more than one owner of the land all owners' details are required



Table A - owner's consent provided on form
                                                                         Date
Owner's name/s
                                                                         Table A - owner's consent provided on form
I/We, the above-mentioned owner/s of the land, consent                                                      hbLZi^;^ S i:>IL.
to the making of this request.                                           nwn is r,am Is

Signature/s                                                              9'fhe owner's written consent is attached.




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