Change Existing Approval Form

4. Location of the premises

   

 

 

DIARENS. eee eG etree! S UW ______
Suburb = \pwosA, HEADS ate GUD Postcode 4567
Lot no. fue ee moe

SP 176340

 

 

 

 

 

 

 

5. Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval? O No

 

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.

foci teCuwe laatg Date copy given

Seren CroRMeR DRM) TBA

 

 

 

6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?

No O Yes
If yes, please attach a copy of the notice.

yee Tae meer d

Is the owner’s consent required for this request? Ol No
WYes— complete either Table A or Table B below
Note — If more than one owner of the land all owners’ details are required

 

 

Be oe ee aay ie meme) Table B — owner’s consent provided on form

STARCO AOLOWAS ITY LM)

Owner's name/s SSIES Owner's name/s

 

IWe, the above-mentioned owner/s of the land, consent he owner’s written consent is attached.
fo the’ making of this request: (amma :

 

 

Signature/s La ed

Date