Works to a dwelling in a conservation area – Application form

1. Applicant Name and Address

2. Agent Name and Address

Local Planning Authority details:

Publication on Local Planning Authority websites

Information provided on this form and in supporting documents may be published on the authority's planning register and website.

Please ensure that the information you submit is accurate and correct and does not include personal or sensitive information.

If you require any further clarification, please contact the Local Planning Authority directly.

Upon receipt of this form and any supporting information, it is the responsibility of the Local Planning Authority to inform you of its obligations in regards to the processing of your application. Please refer to its website for further information on any legal, regulatory and commercial requirements relating to information security and data protection of the information you have provided.

Please be aware that once you have downloaded this form, Planning Portal will have no access to the form or the data you enter into it. Any subsequent use of this form is solely at your discretion, including the choice to complete and submit it to the Local Planning Authority in agreement with the declaration section.

Privacy Notice

This form is provided by Planning Portal and based on the requirements provided by Government for the sole purpose of submitting information to the Local Planning Authority in accordance with the legislation detailed on this form and 'The Town and Country Planning (Development Management Procedure) (England) Order 2015 (as amended).

If you would rather make this application online, you can do so on our website:

https://www.planningportal.co.uk/apply

You are advised to read the accompanying guidance notes and per-question help text.

This form is specifically designed to be printed and completed offline.

Please complete this form in block capitals using black ink to facilitate scanning.

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4. Site Address Details

Please provide the full postal address of the application site.

Description of location or a grid reference.

(must be completed if postcode is not known):

5. Pre-application Advice

Has assistance or prior advice been sought from the local authority about this application? Yes No

If Yes, please complete the following information about the advice you were given. (This will help the authority to deal with this application more efficiently).

Please tick if the full contact details are not known, and then complete as much as possible:

(must be pre-application submission)

Details of the pre-application advice received:

Has the work already started? Yes No

If Yes, please state when the work was started (DD/MM/YYYY): (date must be pre-application submission)

Has the work been completed? Yes No

If Yes, please state when the work was completed (DD/MM/YYYY): (date must be pre-application submission)

3. Description of Proposed Works

Please describe the proposed works:

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8. Parking

Will the proposed works affect existing car parking arrangements? Yes No

If Yes, please describe:

9. Authority Employee / Member

It is an important principle of decision-making that the process is open and transparent. For the purposes of this question, "related to" means related, by birth or otherwise, closely enough that a fair-minded and informed observer, having considered the facts, would conclude that there was bias on the part of the decision-maker in the local planning authority.

Do any of the following statements apply to you and/or agent? 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

Yes No

If Yes, please provide details of their name, role and how you are related to them.

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? Yes No

If Yes, please mark their position on a scaled plan and state the reference number of any plan(s)/drawing(s):

Will any trees or hedges need to be removed or pruned in order to carry out your proposal? Yes No

If Yes, please show on your plans which trees by giving them numbers e.g. T1, T2 etc, state the reference number of the plan(s)/drawing(s) and indicate the scale.

6. Pedestrian and Vehicle Access, Roads and Rights of Way

Is a new or altered vehicle access proposed to or from the public highway? Yes No

Is a new or altered pedestrian access proposed to or from the public highway? Yes No

Do the proposals require any diversions, extinguishments and/or creation of public rights of way? Yes 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)

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11. Explanation For Proposed Demolition Work

Why is it necessary to demolish all or part of the building(s) and or structure(s)?

10. Materials

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

Are you supplying additional information on submitted plan(s)/drawing(s)/design and access statement? Yes No

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

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12. Biodiversity Net Gain

Paragraph 13 of Schedule 7A of the Town and Country Planning Act 1990 sets out that every planning permission granted for the development of land in England shall be deemed to have been granted subject to the 'biodiversity gain condition' requiring development to achieve a net gain of 10% of biodiversity value.

It is my belief that if permission is granted for the development to which this application relates the biodiversity gain condition would not apply

This is subject to exemptions, an exemption applies in relation to planning permission for a development which is the subject of a householder application, within the meaning of article 2(1) of the Town and Country Planning (Development Management Procedure) (England) Order (2015)*.

Applicants for planning permission are required to make a statement as to whether they believe the biodiversity gain condition will apply if permission is granted, please confirm:

* A "householder application" means an application for planning permission for development for an existing dwellinghouse, or development within the curtilage of such a dwellinghouse for any purpose incidental to the enjoyment of the dwellinghouse which is not an application for change of use or an application to change the number of dwellings in a building.

13. 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 2015 Certificate under Article 14

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* 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 is part of, an agricultural holding**

NOTE: You should sign Certificate B, C or D, as appropriate, if you are the sole owner of the land or building to which the application relates but the land is, or is part of, an agricultural holding.

* “owner” is a person with a freehold interest or leasehold interest with at least 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.

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

CERTIFICATE OF OWNERSHIP - CERTIFICATE B

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14

I certify/ The applicant certifies that I have/the applicant has given the requisite notice to everyone else (as listed below) 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 or building to which this application relates.

* “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 1990

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

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13. Ownership Certificates and Agricultural Land Declaration (continued)

CERTIFICATE OF OWNERSHIP - CERTIFICATE C

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14

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 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 1990

The steps taken were:

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

CERTIFICATE OF OWNERSHIP - CERTIFICATE D

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14

I 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 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 1990

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

The steps taken were:

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

(date cannot be pre-application)

15. Declaration

I/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional information. I/we confirm that, to the best of my/our knowledge, any facts stated are true and accurate and any opinions given are the genuine opinions of the person(s) giving them.

16. Applicant Contact Details

Telephone numbers

17. Agent Contact Details

Telephone numbers

18. Site Visit

Can the site be seen from a public road, public footpath, bridleway or other public land? Yes No

If the planning authority needs to make an appointment to carry out a site visit, whom should they contact? (Please select only one) Other (if different from the agent/applicant's details) Agent Applicant

If Other has been selected, please provide:

14. Planning Application Requirements - Checklist

*National legislation specifies that the applicant must provide the original plus three copies of the form and supporting documents (a total of four copies), unless the application is submitted electronically or, the LPA indicate that a smaller number of copies is required. LPAs may also accept supporting documents in electronic format by post (for example, on a CD, DVD or USB memory stick).

You can check your LPA's website for information or contact their planning department to discuss these options.

Please read the following checklist to make sure you have sent all the information in support of your proposal.

Failure to submit all information required will result in your application being deemed invalid. It will not be considered valid until all information required by the Local Planning Authority (LPA) has been submitted.

• The original and 3 copies* of a completed and dated application form:
• The original and 3 copies* of other plans and drawings or information necessary to describe the subject of the application:
• The original and 3 copies* of the plan which identifies the land to which the application relates drawn to an identified scale and showing the direction of North:
• The correct fee:
• The original and 3 copies* of the completed, dated Ownership Certificate (A, B, C or D – as applicable) and Article 14 Certificate (Agricultural Holdings):
• The original and 3 copies* of a design and access statement if proposed works fall within a conservation area or World Heritage Site, or relate to a Listed Building: