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MODIFY A DEVELOPMENT CONSENT under Section 4.55 of the Environmental Planning and Assessment Act 1979

APPLICATION NUMBER:

Application no.: PPIA DISCLAIMER – The personal information provided on this form is collected by Eurobodalla Shire Council for the purposes of processing this application by Council employees and other authorised persons. This form will be stored within Council’s record management system and may be available for public access and/or disclosure under various NSW Government legislation. Visit www.esc.nsw.gov.au/privacy for more information.

PART 1 - APPLICANT’S DETAILS

(Your name and postal address)

Title: Mr Mrs Miss Ms Other

Family name (or company): Given names (or ACN):

Postal address: Postcode: Phone: (w) (h) (m)

Contact person: Email:

Signature(s): Date:

PART 2 - LOCATION DETAILS

Unit no.: House no.: Street: Locality/Town:

Lot(s): Section: DP/SP:

PART 3 - /hb{9b¢ hC h²b9wό{ύ

Title: Mr Mrs Miss Ms Other

Family name (or company): Given names (or ACN):

Postal address: Postcode:

Phone: (w) (h) (m)

Signature(s): Date:

Date:

Date PART 4 - DEVELOPMENT DETAILS

Original development consent no.: Original date of determination of DA:

PART 5 – MODIFICATION TYPE

Section 4.55(1) A modification to correct a minor error, misdescription or miscalculation

Section 4.55(1)(a) A modification which will have minimal environmental impact

Section 4.55(2) Any other modifcation

Section 4.55(8) A modification to a development consent granted by the Court

Cnr Campbell and Vulcan St PO Box 99 MORUYA NSW 2537

Telephone: 02 4474 1000 Facsimile: 02 4474 1234

E: council@esc.nsw.gov.au

www.esc.nsw.gov.au

A *A modification application can only be determined by by Council if changes being made, do not substantially change the original development.

PART 6 - MODIFICATION DETAILS

DETAILS AND JUSTIFICATION OF AMENDMENT(S) TO CONDITIONS OF CONSENT

(use separate pages if required).

CONDITION NUMBER

REASONS FOR AMENDMENT/DELETION

DESCRIBE ANY CHANGES TO PLANS

Page 2

PLEASE DESCRIBE THE EXPECTED IMPACTS OF THE MODIFICATIONS AND ANY MEASURES PROPOSED TO MITIGATE THESE IMPACTS

Applicant’s signature Duty Development Officer Date

PART 7 – CHECKLIST - REQUIRED

Have you included the following information in conjunction with this form? Please tick appropriate box

YES NO Office use

Are you lodging your Application for Modification electronically? If yes, refer to ‘e-lodgement fact sheet’.

Are you lodging your application form in hard copy format?

Have you read the ‘Preparing Plans Fact Sheet’?

One complete set of all plans and documentation to support the application must be supplied.

A completed application form.

One set of plans showing the new work subject of this application.

The work proposed in this application must be either coloured or clearly highlighted on all sets of submitted plans.

One set of plans provided if modification of Construction Certificate

YES NO Office use

MAY BE REQUIRED

A notification plan (on A4 or A3 size paper) which shows the location of all proposed YES NO Office use works on the 4 elevations and on the site plan.

An amended BASIX Certificate (see www.basix.nsw.gov.au).

COUNCIL PCA CONSTRUCTION CERTIFICATE

YES NO Office use

Does the modification propose changes to the building(s) or structures?

If Council is the Accredited Certifier, refer to modification of Construction Certificate form.

OFFICE USE ONLY

File no.: Application no.:

PIN(s): DA no.:

Fee: $

Receipt no.: Date of receipt: Page 3