1. SPA request-change-existing-approval-form · MCU16/0084

Table C—premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g.
channel dredging in Moreton Bay)

Coordinates                                                     Zone        Datum          Local government
(note: place each set of coordinates in a separate row)         reference                  area (if applicable)

Easting          Northing         Latitude         Longitude


                                                                               GDA94
                                                                               WGS84
                                                                               Other



5. Details of the proposed change


 Please refer to cover letter




6. Is owner’s consent required for this request? (refer to notes at the end of this form for more information)


       No

 x     Yes—complete either table D or table E as applicable

Table D

Name of owner of the land

I, the above-mentioned owner of the land, consent to the making of this request.

Signature of owner of the land


Date


Table E

Name of owner of the land                    Denmac Nominees Pty Ltd
 x     The owner’s written consent is attached




Request to change existing approval template                                                                -3-