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vorrel Borough Council

t--24)1q t

Planning Services

Town Hall, The Boulevard

CRAW LEY

West Sussex, RH10 lUZ

t: 01293 438512

e: development.control©crawley.gov.uk

Householder Application for Planning Permission for works or extension to a dwelling.

Town and Country Planning Act 1990

You can complete and submit this form electronically via the Planning Portal by visiting www.planningportalgov.uk/apply

Publication of applications on planning authority websites

Please note that the information provided on this application form and in supporting documents may be published on the

kuthority's website. If you require any further clarification, please contact the Authority's planning department.

)lease complete using block capitals and black ink.

t is important that you read the accompanying guidance notes as incorrect completion will delay the processing of your application.

1 . Appl icant

Tit le :

Last name:

Company (opt iona l) :

U n it :

House

name:

Add ress 1 :

Add ress 2 :

Add ress 3 :

Town :

Cou nty:

Country:

Postcode:

Name and Address

F i rst name :

2. Agent

Tit le :

Last name:

Company

(optiona l ) :

Un it :

House

name:

Add res s 1 :

Add ress 2 :

Address 3 :

Town :

Cou nty:

Country:

Postcode :

Name and Address

F irst name : thia vAtf 14 itk

(C ue_

House

number:

House

suffix:

House

number:

House

suffix:

eits r41 t C.% (.4 .4-J4=7 etsk,A.P

gl(A.A,6 Futui

ek-F-T ( en_

3. Description of Proposed Works

Please describe the proposed works:

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Description of Proposed Works (continued)

as the work already started? (1"-4Y

es

Yes, please state when the work was started (DD/MM/YYYY):

as the work already been completed?

No

/12 Yes I I No

Yes, please state when the work was completed (DD/MM/YYYY):

(date must be pre-application submission)

(date must be pre-application submission)

• Site Address Details

ease provide the full postal address of the application site.

House

suffix: nit:

ouse ame:

ddress 1:

ddress 2:

idress 3:

)wn:

)Linty:

Istcode

ptional):

House

number:

/1-1 il, ec-i cANAr

Pre-application Advice

s assistance or prior advice been sought from the local

thority about this application? I I Yes 2 No

es, please complete the following information about the advice

.1 were given. (This will help the authority to deal with this

)11cation more efficiently).

ase tick if the full contact details are not

Awn, and then complete as much possible:

ficer name:

ri

ference:

Date (DD MM YYYY):

1st be pre-application submission)

tails of the pre-application advice received:

Parking

the proposed works affect

,ting car parking arrangements?

es, please describe:

Yes 1—(.4"No

°N

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e5. Pedestrian and Vehicle Access, Roads and Rights of Way 1

Is a new or altered vehicle access

proposed to or from the public highway?

Is a new or altered pedestrian access

proposed to or from the public highway?

Do the proposals require any diversions,

extinguishments and/or creation of public

rights of way?

II

[

I I

Yes 2 No

Yes ef:2 No

Yes j21' No

If Yes to any questions, please show details on your plans or

drawings and state the reference number(s) of the plan(s)/

drawing(s):

s.

r-7. Trees and Hedges

Are there any trees or hedges on your own

property or on adjoining properties which

are within falling distance of your proposed

development?

If Yes, please mark their position on a scaled

plan and state the reference number of any plans or drawings:

II Yes lil No

Will any trees or hedges need

to be removed or pruned in

order to carry out your proposal?

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n Yes ‘171 No

If Yes, please show on your plans which trees by giving them

numbers e.g. 11,12 etc, state the reference number of the plan(s)/

drawing(s) and indicate the scale.

r

9. Authority Employee / Member

With respect to the Authority, I am:

(a) a member of staff Do any of these

(b) an elected member statements apply to you?

(c) related to a member of staff

(d) related to an elected member

If Yes, please provide details of the name, relationship and role

Yes V No

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10. Materials

f applicable, please state what materials are to be used externally. Include type, colour and name for each material:

Exist i ng

(where app l icable) Proposed

Don 't Know

Wa l ls g /..4 L ic. / e—c—A0 0 i"13 CIL.4\00(4L Fl I I

Roof ri (S__ / rz-401--)

Windows (no ()- CA4Vc- H

Doors input- vita vc_ fl

Bounda ry t reatments

(e .g . fences, wa l ls) Li

Veh ic l e access and

ha rd-stan d i ng

77/4-411 WC- / ag-i,Re....c—'7C—

fi/hfia0(1/ rii iv- ; LA I I

Lig ht i ng

,

I 1

Others

( p lea se specify) 1 I

kre you supplying additional information on submitted plan(s)/drawing(s)/design and access statement?

F Yes, please state references for the plan(s)/drawing(s)/design and access statement:

Yes j2No

ts s nrs L C A A

1. Ownership Certificates and Agricultural Land Declaration

One Certificate A, B, C, or D, must be completed with this application form

CERTIFICATE OF OWNERSHIP - CERTIFICATE A

Town and Country Planning (Development Management Procedure) (England) Order 2010 Certificate under Article 12

zertifyahe applicant certifies that on the day 21 days before the date of this application nobody except myself/ the applicant was the wner*of any part of the land or building to which the application relates, and that none of the land to which the application relates is, or part of, an agricultural holding**

OTE: You should sign Certificate B, C or D, as appropriate, if you are the sole owner of the land or building to which the

pplication relates but the land is, or is part of, an agricultural holding.

"owner" is a person with a freehold in terest or leasehold in teres t with a t leas t 7 years left to run . "agricultural holding" has the meaning given by reference to the definition of "agricultural tenant" in section 65(8) of the Act.

igned - Applicant: Or signed - Agent: Date (DD/MM/YYYY):

CERTIF ICATE OF OWNERSHIP - CERTI FICATE B Town and Count ry Plan n ing (Development Management Procedure) (Eng land) Order 201 0 Cert ificate u nder Art i cle 1 2

certify/ The appl icant cert i fies that I have/the appl i ca nt ha s g iven th e requ i s i te not i ce to eve ryone e l s e (as l i sted be low) who, on the day I days befo re the date of th is a pp l i cat i on , was the owner* a nd/o r ag r icu ltu ra l te nant** of a ny pa rt of the l a nd or bu i l d i ng to wh i ch th is ) p l icat i on re l ates .

"owner" is a person with a freehold interest or leasehold interest with at least 7 years left to run. ' "agricultural tenant" has the meaning given in section 65(8) of the Town and Country Planning Act 1 990

Name of Owne r / Ag r icu l t u ra l Tena nt Add res s Date Noti ce Se rved

ilA( (1\44, (0 Pit'76( 6--2 aNZA) p-4--m-) A4,0 2 7_ s _ 16

Ig ned - App l ica nt :

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' 11. Ownership Certificates and Agricultural Land Declaration (continued)

CERTIFICATE OF OWNERSHIP - CERTIFICATE C

' Town and Country Planning (Development Management Procedure) (England) Order 2010 Certificate under Article 12

I certify/ The applicant certifies that:

• Neither Certificate A or B can be issued for this application

• All reasonable steps have been taken to find out the names and addresses of the other owners* and/or agricultural tenants** of

the land or building, or of a part of it, but I have/ the applicant has been unable to do so.

* "owner" is a person with a freehold in terest or leasehold interest with a t least 7 years left to run.

** "agricultural tenant" has the meaning given in section 65(8) of the Town and Country Planning Act 1 990

The steps taken were:

-N

Name of Owner / Agricultural Tenant Address Date Notice Served

Notice of the application has been published in the following newspaper

(circulating in the area where the land is situated):

Signed - Applicant: Or signed - Agent:

On the following date (which must not be earlier

than 21 days before the date of the application):

Date (DD/MM/YYYY)

CERTIFICATE OF OWNERSHIP - CERTIFICATE D

Town and Country Planning (Development Management Procedure) (England) Order 2010 Certificate under Article 12

certify/The applicant certifies that:

Certificate A cannot be Issued for this application

All reasonable steps have been taken to find out the names and addresses of everyone else who, on the day 21 days before the

date of this application, was the owner* and/or agricultural tenant** of any part of the land to which this application relates, but I

have/ the applicant has been unable to do so. "owner" is a person with a freehold in terest or leasehold in terest with a t least 7 years left to run.

* "agricultural tenant" has the meaning given in section 65(8) of the Town and Country Planning Act 1 990

The steps taken were:

\lotice of the application has been published in the following newspaper On the following date (which must not be earlier

:circulating in the area where the land is situated): than 21 days before the date of the application):

Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):

12. Planning Application Requirements - Checklist

Please read the following checklist to make sure you have sent all the information in

information required will result in your application being deemed invalid. It will not

the Local Planning Authority has been submitted.

The original and 3 copies of a The original and 3 copies of a

completed and dated application form: F--- design and access statement if

proposed works fall within a The original and 3 copies of a plan which identifies the land to which the application

conservation area or

relates drawn to an identified scale World Heritage Site, or relate to a

and showing the direction of North: Listed Building:

The original and 3 copies of other plans and drawings or information necessary to describe the subject of the application: Zr

support of your proposal. Failure to submit all

be considered valid until all information required by

E

The correct fee:

The original and 3 copies of the

completed, dated Ownership

Certificate (A, B, C or D — as

applicable) and Article 12

Certificate (Agricultural Holdings):

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13. Declaration

/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional

nformation. I/we confirm that, to the best of my/our knowledge, any facts stated are true and accurate and any opinions given are the

jenuine opinions of the person(s) giving them,

Signed - Applicant: Or sign gent: Date (DD/MM/YYYY):

4. Applicant Contact Details

'elephone numbers

:ountry code: National number:

:ountry code: Mobile number (optional):

ountry code: Fax number (optional):

mail address (optional):

Extension

number:

21, (date cannot be

pre-application) ■

e15. Agent Contact Details

Telephone numbers

Country code: National number:

Country code: Mobile number (optional):

Country code: Fax number (optional):

Email address (optional):

'N

Extension

number:

6. Site Visit

in the site be seen from a public road, public footpath, bridleway or other public land? .prYes

.he planning authority needs to make an appointment to carry

it a site visit, whom should they contact? (Please select only one)

3ther has been selected, please provide:

Dntact name:

nail address:

Agent 2'Applicant

Telephone number:

No

Other (if different from the

agent/applicant's details)

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