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iCrawley Borough Council

Planning Services

Town Hall, The Boulevard

CRAWLEY

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.planningportal.gov.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

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

Please complete using block capitals and black ink.

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

1. Applicant Name and Address

Title:

Last name:

Company

(optional):

Unit:

House

name:

Address 1:

Address 2:

Address 3:

Town:

County:

Country:

Postcode:

First name: Ak.0

1_64(10-C/I-A 01-

House

number: tfo House

suffix:

lvt4 0(2-1=C674A

e-ip os /-1

nzaul tecd

CPI"-

p_1-t (1 gyitg

2. Agent Name and Address

Title:

Last name:

Company

(optional):

Unit:

House

name:

Address 1:

Address 2:

Address 3:

Town:

County:

Country:

Postcode:

First name:

House

nurnber:

House

suffix.

3. Description of Proposed Works

Please describe the proposed works:

Smd or

RECEIVED

31 MAY 2012

ENVIRONMENT AND

HOUSING! DIRECTORATE

$Date 201009-1O#$ $Revision 2998$

t k e n . r..) ..-) 17. ' ", i p 4 1 1 I : a

e3. Description of Proposed Works (conti ued)

Has the work already started? I Yes No

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

Has the work already been completed? I4Yes Eli No

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

Li) a

a

(date must be pre-application submissioi

(date must be pre-application submission

4. Site Address Details

Please provide the full postal address of the application site.

House

number: Unit:

House

name:

Address 1:

Address 2:

Address 3:

Town:

County:

Postcode

(optional):

House

suffix:

te4,1266--Tzts

Monorh ids

13mbush

Py644.11.- Cr° Ki icy

INQS`t 5u55 ex

H

6. Pre-appl ication Advice

Has ass i sta nce or pr ior adv i ce been sought from he loca l

a uthority a bout th is a pp l i cat ion? F..; Li j e.,..s 1—<ko

,--

I f Yes, p l ease comp lete the fo l lowing informat i on a bout the advi ce

you were g i ven (Th i s wi l l he l p the a uthori ty to dea l with th i s

a pp l icat i on more effic i ent ly) .

P l ea se t i ck if the fu l l contact d eta i l s a re not

known, a nd then complete a s much poss ib le : I I

Office r name:

Of 1)cmc) Lex, Vianntrq Alm Refe rence: t"

Date (DD MM YYYY) :

(m ust be pre-a pp l i cat ion su bm i ss i on)

Deta i l s of the pre-app l i cat ion advi ce rece ived :

8. Parking

Will the proposed works affect

existing car parking arrangements?

If Yes, please describe:

n Yes /No.

5. Pedestrian and Vehicle Access, Roads and Rights of Wa

Is a new or altered vehicle access

proposed to or from the public highway? I I Yes No

Is a new or altered pedestrian access

proposed to or from the public highway? I Yes o

Do the proposals require any diversions,

extinguishnnents and/or creation of public

rights of way? II Yes N40 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):

■

e7. 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? n Yes

If Yes, please mark their position on a scaled

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

v(No

Will any trees or hedges need

to be removed or pruned in

order to carry out your proposal? n Yes No

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

numbers e.g. Ti, T2 etc, state the reference number of the plan(s)/

drawing(s) and indicate the scale.

9. Authority Employee / Member

With respect to the Authority, I am:

(a) a member of staff

(b) an elected member

(c) related to a member of staff

(d) related to an eleCted member

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

Do any of these

statements apply to you?

n Yes I *qiNo

$Date 2010-09-10#$ $flevislon 2998$

10. Materials

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

, 1

Existi ng

(whe re a ppl ica bl e) P roposed

Don't

Know

Wa l l s W 0 wood an d pl us-kr

)9 001 1f OIS

I I

Roof M5-1-i c I I

Windows 9w55 lirornc

Doors wooden

Bounda ry t reatments

(e .g . fences, wa l l s)

Veh i c le access a nd

ha rd-sta nd i ng

L ight i ng \ Vpi 1)U 1 19 fl

Othe rs

(p l ea se s pec ify) I

-

Are you supplying additional information on su mitted esign aid access statement?

If Yes, please state references for the plan(s)/dra ing(s)/design and access statemer t:

3 I MAY 2012 loy m\b04- ENVIRONMENT AND

f11.0-1 0-1ING DIRECTORATE `1

I i/Yes No

$Date 2010-09-10 8$ $Revision 2998$

11. Ownership Certificates

One Certificate A, B, C, or D, must be completed, together with the Agricultural Holdings Certificate with this application form

CERTIFICATE OF OWNERSHIP - CERTIFICATE A

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

I certify/The applicant certifies that on the day 21 days before the date of this application nobody except myself/the applicant was the

owner (owner is a person with a freehold in terest or leasehold in terest with at least 7 years left to run) of any part of the land or building to

wn i cn me ap

S i g ned - A

[ ' cat ion re l ates .

i ca nt : Or signed - Agent: Date (DD/MMNYYY) :

CERTIFICATE OF OWNERSH I P - CERTIFICATE B

Town and Country Plann ing (Development Management Procedure) (Eng land) Order 201 0 Certificate under Art i c le 1 2

I cert ify/ The app l i ca nt cert i f i es that I have/th e a pp l ica nt ha s g iven the req u i s ite not ice to eve ryone el se (as l i sted be low) who, on th e da'

2 1 d ays before the date of th is a pp l icat ion, was the owner (owner is a person with a freehold in terest or leasehold in terest with at leas t 7 year

left to run) of a ny pa rt of the l a nd or b u i l d i ng to wh ich th i s appl i cat ion re l ates .

Name of Owner Add ress Date Not i ce Se rved

S i gned - App l icant : Or signed - Agent : Date (DD/MM/YYYY) .

CERTIF ICATE OF OWNERSHIP - CERTI F ICATE C

Town and Country Plann ing (Development Management Procedure) (Eng la nd) Order 201 0 Certifi cate under Art i c le 1 2

I cert ify/ The appl i cant ce rt i f ies that :

• Neither Ce rt i fi cate A o r B ca n be iss ued fo r th is a pp l i cat ion

• Al l reasonab l e steps have been ta ken to fi nd out the names a nd add resses of the other owners (owner is a person with a freehold

in terest or leasehold in terest with a t least 7 years left to run) of the l and or bu i l d i ng , o r of a part of it , but I have/ the a pp l ica nt has

been u nab le to do so.

The steps ta ken were:

Name of Owner Add ress Date Not i ce Se rved

Not i ce of the app l i cat ion ha s been pub l i s hed i n the fo l l owi ng newspaper On the fol l owi ng date (wh i ch must not be ea r l i e r

(c i rcu l at i ng i n the a rea where the l a nd i s s ituated) : than 2 1 days befo re the date of the a pp l icat ion) :

S ig ned - App l ica nt . Or sig ned - Agent : Date (DD/MM/YYYY) :

$Date 2010-09-10#$ $Revision 2998$

11 . Ownersh ip Certificates (continued)

CERTIFICATE OF OWNERSHIP - CERTIFICATE D

, Town and Country P lann i ng (Development Management Procedure) (Eng land) Order 201 0 Certifi cate under Art i c le 1 2

I ce rt ify/ The app l i ca nt cert ifies that : • Certifi cate A ca nnot be is sued fo r th is a pp l icat ion • Al l reasonable steps have been ta ken to fi nd out the names a nd addresses of eve ryone e l se who, on the day 2 1 days before the

date of this appl ication, was the owner (owner is a person with a freehold in terest or leasehold interest with at least 7 years left to run)

of a ny pa rt of the l a nd to wh ich th is a pp l i cat i on re l ates, but I have! the a ppl i cant has been u nable to do so.

The steps taken were:

N ot i ce of the a pp l i cat ion has been publ i s hed in the fo l l owi ng newspaper • ust not be ea rl ie r

(c i rcu l at i ng i n the a rea where the l a nd is s i tuated) : ti Jthe appl i cat ion) :

.iimiummo

Sig ned - App l i ca nt : Or s ig ned - Agent : Date (DD/MMNYYY) :

12. Agricultural Land Declaration

AGRICULTURAL LAND DEC1.4111111111111111111.1111111.11111

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

Agricultural Land Declaration - You Must Complete Either A or B

(A) None of the land to which the application relates is, or is part of, an agricultural holding.

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

1 s)64 12_

(B) I have! The applicant has given the requisite notice to every person other than myself/ the applicant who, on the day 21 days

before the date of this application, was a tenant of an agricultural holding on all or part of the land to which this application relates,

as listed below:

Name of Tenant Address Date Notice Served

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

e13. 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: El 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

relates drawn to an identified scale

and showing the direction of North:

The original and 3 copies of other plans

and drawings or information necessary to REC D describe the subject of the application:

LI

conservation area or

World Heritage Site, or relate to a

Listed Building:

.namaz■NMEN.M.M.......=ZSar

support of your proposal. Failure to submit all

be considered valid until all information required by

E

LI

The correct fee:

The original and 3 copies of the completed, dated Ownership Certificate (A, B, C or D - as applicable):

LI

LI

The original and 3 copies of the

completed, dated Article 12 Certificate LI

(Agricultural Holdings):

3 tY1'

ENVIRO`i\AiEva I-do)

FlallaiK4S.LRE $Date 2010-09-101/5 $RevIston 2998$

e

14. Declaration

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

information.

Signed - Ap, cant: Or signed - Agent: Date (DD/MMNYYY):

(date cannot b

pre-applicatior

'15. Applicant Contact Details

Telephone numbers

Country code: National number:

1111111111111111r Country code: Mobile number (optional):

E----- Country code: Fax number (optional):

Email address (optional):

Extension

number:

‘.111111111111111111111111111111111111111111PM

1 r 16. Agent Contact Details

Telephone numbers

Country code: National number:

Country code: Mobile number (optional):

Country code: Fax number (optional):

Email address (optional):

Extension

number:

r . . . 17. Site Visit

Can the site be seen from a public road, public footpath, bndleway or other public land?

If the planning authority needs to make an appointment to carry

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

If Other has been selected, please provide.

Contact name:

S.-

Email address:

I 1 Agent

II

Telephone number:

Yes 11-1113

pplicant F-1 Other (if different from the

" agent/applicant's details)

Spate 2010 09-10 8$ Sevislon 2998$