-41

a

Crawley Borough Council

CC0` FUL—

RECIEWED

20 DEC 2012

Planning Services

Town Hall, The Boulevard

CRAWLEY

West Sussex, RH10 1UZ

t: 01293 438512

e: development.control@crawley.gov.uk

Application for Planning Permission.

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:

R._ First name: J

IL °SS

So 'VI's-Q-4-A k--I( 00S. Al a

House

suffix:

I House

number:

QQk \-t_OL)

b CLs2_1--kA-ftw-eA

EC- A M St_

2. Agent Name and Address

Title: First name:

Last name: 172_ r\ v

Company

(optional):

Unit:

House

name:

Address 1:

6-A-c6fv\i- -"C:vvokS

House

number:

House

suffix:

Address 2: 1".)

Address 3:

Town:

County:

Country: Country:

Postcode: I 2.-(0 b to

E

3. Description of the Proposal

Please describe the proposed development, including any change of use:

..0,eLav\A_Q E.-0-s..\-;w4 1.0 vy•fkows ,);14\ P VC kkimekows

\P6,-* 61 71 g KJQA64i

Has the building, work or change of use already started?

If Yes, please state the date when building,

work or use were started (DD/MM/YYYY):

II Yes N1,1(o

Has the building, work or change of use been completed?

If Yes, please state the date when the building, work

or change of use was completed: (DD/MM/YYYY):

(date must be pre-application submission)

Yes 11410

1 (date must be pre-application submission)

Spate:: 201/.07-17 1$ Sfivvillont 4636 S

4. Site Address Details

Please provide the full postal address of the application site.

Unit:

House

name:

Address 1:

Address 2:

Address 3:

Town:

County:

Postcode

(optional):

1 Hou se l e-

I number: [--) — 6 I

Hou se

s uffix:

1

1 WQ-4" k.e-A-cs CUD S-IZ

C (-6.. kA.)L.. ..

Description of location or a grid reference.

(must be completed if postcode is not known):

Easting: j

Northing:

Description:

2.

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

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?

LI Yes

Yes

Are there any new public roads to be

provided within the site? I I Yes VAC°

Are there any new public

rights of way to be provided

within or adjacent to the site?

Do the proposals require any diversions

/extinguishments and/or

creation of rights of way?

Yes

I-1 Yes

P-rfo

If you answered Yes to any of the above questions, please show

details on your plans/drawings and state the reference of the plan

(s)/drawings(s)

S . Pre-appl ication Advice

Has ass i sta nce o r p r ior adv i ce been so ug ht from the l oca l

a utho r i ty abou t th i s app l icat ion ? pi Yes l l'&o

I f Yes, p lea se complete t he fo l l owi n g i n fo rmat ion a bo ut the advi ce

you were g iven . (Th i s wi l l he l p t he a uth o r i ty to dea l w ith t h is

app l i cati on more effic i e nt ly) .

P lea se t ick if the fu l l co nta ct deta i l s a re not

known , and then comp l ete a s much a s poss i b l e : F

Offi ce r name :

Refe rence:

Date (DD/MM/YYYY) :

(m ust be p re-a pp l i cati on su bm i ss ion )

Deta i l s of p re-app l i cat ion adv ice rece ived?

7. Waste Storage and Co l lection

Do the p l an s i n co rpo rate a rea s to sto re

a nd a i d t he co l l ect i on of waste ?

I f Yes, p l e a se prov ide deta i l s :

_ Yes 1 1.-Ko

Have a rra ngeme nts been made

fo r the sepa rate storage a nd

co l lect i on of recyc la b le waste ?

I f Yes , p l ea se prov ide deta i l s :

I I Yes R-Nlic

8. 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? Li Yes

SDate, 2012-07-17 05 $Revision: 4636 5

9. Materia ls

f app l i ca b l e, p l ea se state what mate ria l s a re to be u sed exte rna l ly. I n c l ude type, co l ou r and name fo r each mate ri a l :

Ex i st i ng

(where a pp l i ca b l e) P roposed

Don 't

Know

Wa l l s

Roof

Wi ndows

-4- r 6AN.-ex- c-0.41-0"-°,4 c...1 ,-_

kA.) D'itko r...- •-. c..o Ttik- SA-0--)-h-‘?-d■

Do 0 .17U- c' 1-0\,2s2-(2k P V. C... k3

cz,,,,e.,,,I i,-) PA-c4u),S . C__oLci-u ,r

6e_. wW; 6.

[-1 1 1

Doors t-1"-- I 1

Bounda ry treatments

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

Veh i c l e access a nd

h a rd-sta nd i ng ±

Lig ht i ng I I

Others

(p l ease spec ify) --LI

A re you su pp ly i ng addit iona l i nfo rmation on subm itted p l a n (s )/d rawi ng (s )/des ig n a nd a ccess sta tement? 1 1.-Yt5-3-

I f Yes, p lea se state references fo r the p l an (s)/d rawi ng (s)/des ig n a nd a ccess sta tement :

No

L

'T& Veh ic le Pa rki ng

P l ease p vi e i nfo rmat ion on the ex i st i ng a nd proposed n umbe r of on-s i te pa rki ng s paces :

Type of Veh i c l e Tota l

Ex i st i ng

Tota l p roposed (i n c l ud i ng

spaces reta i ned)

D iffe re nce

i n spaces

Ca rs

L i g ht goods veh i c les/

pu b l i c ca r r ie r veh ic l es

Moto rcyc les

D i s a b i l i ty spaces

Cyc l e spaces

Other (e .g . B u s)

Othe r (e .g . B us)

$Date:: 2012-07-17 NS $Revislon:4636 $

• Foul Sewage

Plea state how foul sewage is to be disposed of:

1 I ins sewer

Septic t

Package treat

Are you proposing to

connect to the existing drainag stem? ri Yes I I No

nt plant

Cess pit

I Other

If Yes, please include the details of th existing system on the

application drawings and state referen for the

plan(s)/drawing(s):

13. Biodiversity and Geological Conservation

To assist in answering the following questions refer to the guidance

notes for further information on when there is a reasonable

likelihood that any important biodiversity or geological

conservation features may be present or nearby and whether

they are likely to be affected by your proposals.

Having referred to the guidance notes, is there a reasonable

likelihood of the following being affected adversely or conserved

and enhanced within the application site, or on land adjacent to

or near the application site?

a) Protected and priority species:

nYes, on the development site

ri Yes, on land adjacent to or near the proposed development

rrNo

b) Designated sites, important habitats or other biodiversity

features:

I 1 Ii

Yes, on the development site

Yes, on land adjacent to or near the proposed development

c) Features of geological conservation importance:

Yes, on the development site

Yes, on land adjacent to or near the proposed development

15. Trees and Hedges

Are there trees or hedges on the

proposed development site? Yes No

And/or: Are there trees or hedges on land adjacent to the

proposed development site that could influence the

development or might be important as part

of the local landscape character? Yes

If Yes to either or both of the above, you may need to provide a full

Tree Survey, at the discretion of your local planning authority. If a

Tree Survey is required, this and the accompanying plan should be

submitted alongside your application. Your local planning

authority should make clear on its website what the survey should

contain, in accordance with the current 'BS5837: Trees in relation to

construction - Recommendations'.

12. Assessment of Flood Risk

Is the site within an area at risk of flooding? (Refer to the

Environment Agency's Flood Map showing flood zones 2 and 3 and

consult Environment Agency standing advice and your local

planning authority requirements for information as necessary.)

I Yes

If Yes, you will need to submit a Flood Risk Assessment to consider

the risk to the proposed site.

Is your proposal within 20 metres of a

watercourse (e.g. river, stream or beck)?

Will the proposal increase

the flood risk elsewhere?

How will surface water be disposed of?

Sustainable drainage system

Soakaway

L Main sewer

I I

II

Yes

Li YesL9

Existing watercourse watercourse

J Pond/lake

14. Existing Use

Please describe the current use of the site:

(6,604,114,:ticLA

Is the site currently vacant? r7 Yes

If Yes, please describe the last use of the site:

When did this use end (if known)?

DD/MM/YYYY

(date where known may be approximate)

Does the proposal involve any of the following?

If yes, you will need to submit an appropriate contamination

assessment with your application.

Land which is known to be contaminated?

Land where contamination is

suspected for all or part of the site?

A proposed use that would

be particularly vulnerable

to the presence of contamination?

Yes

Yes ii--trro

fl Yes

16. Trade Effluent

Does the proposal involve the need to

dispose of trade effluents or waste? I I Yes 1-"I\To

If Yes, please describe the nature, volume and means of disposal

of trade effluents or waste

SDate: 2012-07-I? N O $ Revision. 4636

1 7 . Res identia l Un its ( Inc lud i ng Convers ion )

Does you r p roposa l i n c l ude the ga i n, loss o r cha nge of use of res i den t ia l u n i ts?

I f Yes, p lea se com p lete deta i l s of t he cha n ges i n t he ta b les be low: Yes I t'gr.

P roposed Housing Exist i ng Hous ing

Market

Housi ng Not

known

N umbe r of Bed rooms Tota l Ma rket

Housing Not

k nown

N umbe r of Bed rooms Tota l

1 2 3 4+ U nknown 1 2 3 4+ U n known

Houses • Ho uses 0

F lats a nd ma i sonettes • '" " F l ats and ma isonettes i)

L ive-wo rk u n its • L ive-work un i ts 0

Cl u ste r fl ats Ii C l u ste r f l ats •

She l te red ho us i ng • S h elte red ho us i ng 0

Beds it/st ud i o s • Bed s it/st ud ios •

U n known type LI U n known type •

Tota ls (a + b + c + d + e + f+ g) = Tota ls (a + b + c + d + e + f+ g) =

Socia l Rented Not known

Numbe r of Bed rooms Tota l Soci a l Rented

Not known

N umbe r of Bed rooms Tota l

1 2 3 4+ Unknown 1 2 3 4+ U n known

Houses • Ho uses •

F la ts a nd ma i sonettes • F lats a nd ma i sonettes •

L i ve-work u n i ts • L i ve-work un i ts •

C l u ste r flats • C l u ster flats lil

S he l tered ho us i ng • e S he l te red hou s i ng •

Bed s i t/st ud ios • B eds it/st ud i os • I

U n kn own type • 9 U n known type •

Tota l s (a + b + c + d + e + f+ g) = Total s (a + b + c + d + e + f+ g) =

I ntermed iate N ot

k nown

N umber of Bed rooms Tota l Intermed iate

Not known

N umbe r of Bed rooms Tota l

i 2 3 4+ Unknown 1 2 3 4+ Un known

Ho u ses • Hou ses •

F l ats a nd ma i sonettes • F l ats and ma i son ettes •

Li ve-wo rk un i ts L ive-work un i ts •

C l u ster fl a ts • C l u ste r flats •

S h e l te red ho us i n g • S he l te red hou s ing •

Beds it/st ud i os LI B eds i t/st ud ios

U n known type • U n known type 0

Tota ls (a + b + c + d + e + f+ g) = Tota ls (a + b + c + d + e + f+ g) =

Not N um be r of Bed rooms Tota l K

Not N umbe r of Bed rooms Tota l Key worker

known 1 2 3 4+ Un known ey worker

known 1 2 3 4+ U n known

Hou ses • Houses •

F l ats and ma i sonettes El F l ats a nd ma i sonettes •

L ive-work un it s • L ive-work un i ts LI

Cl u ste r f lats • C l u ste r fl ats •

She lte red hous i ng 0 S h e l tered hou s i ng •

Beds i t/stud ios U Bed s it/st ud ios •

U n known type • U n known type •

Tota l s (a + b + c + d + e + f+ g) = Tota l s (a + b + c + d + e + f+ g) =

I Tota l proposed res identia l u n its (A + B + C+ D) = I

Tota l exist ing res ident ia l u n its (E + F + G + H) = I

TOTAL N ET GA I N or LOSS of RES I DENTIAL UN ITS (Proposed Housing G rand Tota l - Exist i ng Housing Grand Tota l ) 1

Spate:: 2012-07-17 4 $ $Revision:4636 5

18. All Types of Development: Non-residential Floorspace

Does your proposal involve the loss, gain or change of use of non-residential floorspace? Yes

I f yo u have answe red Yes to the quest ion above p lease add deta i l s i n the fo l lowing tab le:

Use c la ss/type of u se

Exi st i ng g ross

i nter na l

floo rspace

(squa re metres)

G ross i nte rna l fl oors pace

to be l ost by cha nge of

u se or demol i t i on

(squa re metres )

Tota l g ross i nterna l

fl oo rspace p roposed

( i n c l ud i ng change of

use) (sq ua re met res)

Net add i t iona l g ross

i n te rna l floo rspace

fo l l owing deve l opment

(sq ua re met res)

A l S hops Lii ,....tr-401.k..

Net t rada b le a rea : Li

A2 F i na nc ia l and

p rofess iona l se rvices

A3 Resta u rants and cafes Li

A4 D ri n ki ng esta b l i s hments Li

AS Hot food takeaways Li

A l (a) Office (other than A2 ) Li

B 1 (b) Resea rch and

deve lopment

B 1 (c) L ight i n dustri a l Li

B2 Gen era l i ndustria l 0

B8 Sto rage o r d i s t r i b u ti on Li

Cl Hote l s a nd ha l l s of

res i dence

C2 Res ident ia l i n st i t ut ions Li

D 1 Non-res identia l

in st it ut ions

D2 Assemb ly and le is u re Li

OTHER Li

P l ease

Spec ify

Tota l

In addition, for hotels, residential institutions and hostels, please additionally indicate the loss or gain of rooms

U sec l ass

Type of u se Not

a pp l icab le

Ex ist i ng rooms to be lost by cha nge

of u s e o r demo l i t i on

Tota l rooms proposed ( i n c l ud i ng

changes of use) Net add it iona l rooms

C l Hote ls Li

C2 Res ident i a l

I n st i tut i ons Li

OTHER Li P lease

Specify Li

19. o rment

Please complete the following information re ing-ern

Full-time

ees:

Part-time Total full-time

e uivalent

Existing employees

Proposed employees

urs of Open ing

P l ease state th e ho u rs of open h non-res ident ia l use proposed :

Use Monday to F ri day t . . S unday and

Bank Ho l idays Not known

21. Site Area . -2_

Please state the site area in hectares (ha) L(.0 2_& s or\

50aW: 2012-07-17 R $ S Revi s lo rr 4636

'22. I nd ustria l or Commercia l Processes and Mach inery

Please descri be the activ i t ies and p rocesses wh ich wou ld

be ca rr i ed out on the s i te and the end products i nc l ud i ng

p l an t, vent i l at io n or a i r cond it ion i ng . P l ea se i nc l ude the

type of mach i ne ry wh i ch may be i nsta l led on s ite :

I s the p roposa l a waste management deve l o pment? I I Yes EI-Vro

I f the answer i s Yes, p l ea se comp lete t he fo l l owi ng ta b le :

W II fo t.,

.,—

',E; 76 Z n3

T f the void i n cu b ic metres,

i n surcha rge a nd ma k i ng no

a l owance or co er r resto ratio n materi a l (o r

ton nes i f so l id waste o r l i t res i f l iqu id waste)

Maximum a nn ua l ope ration a l

th roughput i n ton nes (o r l i t re s i f l iq u id waste)

I n ert l a ndfi l l LI

Non-haza rdo us l andfi l l LIII t

Haza rd ous l a ndfi l l LII

E ne rgy from waste i nc i ne ra t i o n LI

Other i nc i nerati on LII

La ndfi l l gas gene ration plan t Lii

Pyrolys is/gas ifi cation LI

Metal recyc l i ng si te LI

Transfe r station s LI

Mate ri a l recovery/recyc l i ng fac i l i t i es (MRFs) fl

Househo ld c ivic amen ity s i te s LII

Open wind row compost i n g

I n-vesse l compost i ng

Anae robi c d igest i on LIII Any combined mecha n ica l , b io l og ica l and/

or therma l treatment (MBT)

Sewage treatment works

Oth er t reatment

Recyc l i ng faci l i t i es constr u ct io n, demo l i t ion a nd excavat i on waste

Storag e of waste LII

Other waste ma nagement Lii

Oth er devel opments Lii

Plea se prov ide the maximum annua l operat i ona l th roug hpu t of the fol l owi ng waste streams:

M un i c i pa l

Co n struct i on , demo l i t i on and excavat i on

Commerc i a l and i nd ust r i a l

Haza rd o u s

[ I f t h i s i s a landfi l l a pp l icat i on you wi l l need to p rovi de fu rt he r i nformat i on before yo u r a pp l icat i on ca n be dete rm i n ed . You r waste

p la n n i ng a u th o r i ty sh o u ld m a ke c l ea r wha t i nform at i on i t req u i res on i ts webs i te. ..

'.3. Hazardous Substances

Does the proposal involve the use or storage of any of

the following materials in the quantities stated below? Ell Yes 111410— D Not applicable

If Yes, please provide the amount of each substance that is involved:

Acrylonitrile (tonnes)

Ammonia (tonnes)

Bromine (tonnes)

Chlorine (tonnes)

Other:

Ethylene oxide (tonnes)

Hydrogen cyanide (tonnes)

Liquid oxygen (tonnes)

Liquid petroleum gas (tonnes)

Amount (tonnes):

Other:

Amount (tonnes):

Phosgene (tonnes)

Sulphur dioxide (tonnes)

Flour (tonnes)

Refined white sugar (tonnes)

Spate 2012-07-1714$ Sflevision:4636 S

'24. Ownersh ip Cert ificates

One Cert ifi cate A, B, C, or D, must be comp leted, together with the Agricu ltura l Ho ld ings Certificate with th is app l i cat ion form

CERTI FICATE OF OWNERSH IP - CERTI F ICATE A

Town and Count ry Plann ing (Development Management Procedu re) ( Eng l and) Order 201 0 Cert ificate under Art ic l e 1 2

I cert i fy/The app l i ca nt ce rt ifies that on the day 2 1 days befo re the date of th is ap p l i cat i o n nobody except myse lf/ t he a pp l i ca nt wa s t he

owne r (owner is a person with a freehold in teres t or leasehold in terestwith a t least 7 years left to run) of any pa rt of t he l and o r bu i l d i ng to

wh i ch the app l icat io n re l ates .

S ig ned - Appl ica nt : Or signed - Agen t : Date (DD/MM/YYYY) :

fp MIN. 2-0/ ( 2/2_0(2_

CERTIF ICATE OF OWNERSH I P - CERTIF ICATE B

Town and Country Plann i ng (Development Management Procedure) ( Eng land) Order 20 1 0 Certificate u nder Art i c l e 1 2

I ce rt i fy/ The a pp l i ca n t ce rti fi es t hat I h ave/the a ppl icant h as g i ven t he req u is ite n ot i ce to everyone e l se (a s l i sted be low) who, on the day

2 1 days befo re thq da te of t h i s app l icat i o n , was tbg owne r (owner is a person with a freehold in teres t or leasehold in terest with a t least 7 years

left to run) of a ny pa rt orthe ' a rid o r b u i ld i ng to wliTch th is a p p l i cati on re lates .

N ame of Owne r Address Date Not ice Served

S igned - Appl ican t: Or s ig ned - Agent : Date (DD/MM/YYYY) :

CERTI F ICATE OF OWNERSH IP - CERTIF ICATE C

Town and Country Plann ing (Development Management Procedure) ( Eng l and ) Order 20 1 0 Cert ificate under Art i c le 1 2

I cert i fy/ The app l i can t ce rt ifi es th at :

• Neither Cert i fi cate A o r B can be issued fo r th i s app l icat i on

• A l l rea sonabl e steps have been taken to fi nd out the names and ad d resses of the othe r owne rs (owner is a person with a freehold

in terest or leasehold in terest with a t least 7 years left to run )of the la nd o r bu i l d i ng, or of a pa rt of i t , b ut I have/ the appl icant ha s

been u nabl e to do so.

The steps ta ken were:

N ame of Owne r Add ress Date Not ice Se rved

Notice of the a pp l i ca t i o n has been publ i shed i n the fo l l owi ng newspape r On the fo l lowing 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 wh e re t he l a nd i s s itu ated) : than 2 1 days before t he date of t he a ppl i cat i on) :

S i g ned - App l ica n t : Or sig ned - Agent: Date (DD/MM/YYYY)

5Date, 2012 07-1700 5Revislon: 4636 5

24. Ownersh ip Cert ifi cates (cont i n ued )

CERTI F ICATE OF OWNERSH IP - CERTI F ICATE D

Town and Country P l a nni ng (Deve lopment Management P rocedu re) ( Eng la nd) Order 20 1 0 Cert ificate u nder Art i c l e 1 2

I cert i fy/ The a p p l i can t ce rt i fi es th at :

• Cert ifi cate A ca n not be iss ued fo r th i s a pp l i cat i on

• Al l reasona b le step s have been ta ken to fi nd o ut the names a nd add resses of eve ryon e e l se who, on the day 2 1 days befo re the date of t h i s ap p l i cat i o n , was the owne r (owner is a person interest or leasehold in terest with a t leas t 7 years left to run ) of a ny pa rt of t he l a nd to wh ich th i s a pp l i cat i on re l at 'cant ha s been u na b l e to do so .

The steps taken were:

Not ice of the app l icat i o n ha s been pu b l i s hed i n t he fo l l owing newspape r On the fo l l owing date (wh i ch m ust not be ea r l ie r

(c i rcu lat i ng i n t he a rea whe re the l a nd i s s ituated ) : than 2 1 da s before t he date of the a • • l icat io n) :

– :

S igned - App l ica n t : Or s ig ned - Agent : Date (DD/MM/YYYY) :

125 . Agricu ltu ra l Land Dec laration

AGR ICULTURAL LAND DECLARATION

Town and Country Pl a nn ing (Deve lopment Management Procedure) (Eng land ) Order 2 0 1 0 Cert ificate u nder Art i c l e 1 2

Ag r icu lt u ra l La nd Dec l a rat ion - You M ust Comp lete E i ther A o r B

(A) None of the l a n d to wh i ch the app l i cat ion re l ates i s, o r i s pa rt of, an ag ri c u l t u ra l ho l d i ng .

S i gned - App l ica nt : Or s igned - Agent : Date (DD/MM/YYYY) :

cr 4141111111k (B ) I h ave/ The a pp l ica nt has g iven t h e req u is i te not i ce to every pe rson othe r t h a n myse l f/ t he app l i cant who, on the day 2 1 days

befo re the date of t h i s a pp l icat i on , was a tena nt of a n ag ri c u l tu ra l h o ld i ng on a l l o r pa rt of t he l a n d to wh ich th i s a pp l i cat ion re l ates, a s l i s ted be low:

Name of Tena nt Add ress Date Notice Se rved

[ S i gn ed - App l ica n t : Or s igned - Agen t : Date (DD/MM/YYYY) :

/

26. Planning Application Requirements - Checklist _ _ Please read the follefiVing checklist to make sure you have sent all the information in support of your proposal. Failure to submit all

information required will result in your4-plfcation being deemed invalid. It will not be considered valid until all information required by

the Local Planning Authority has been submitted. - — The original and 3 copies of a completed and dated The ccirrect fee:

application form: Li _— The original and 3 copies cif-a designand access statement,

The original and 3 copies of the plan which identifies if required (see help text and guidance-nOtes for details): the land to which the application relates drawn to an

identified scale and showing the direction of North: The original and 3 copies of the completed, dated

-

-----

Ownership Certificate (A, B, C, or D - as applicable): The original and 3 copies of other plans and drawings or

information necessary to describe the subject of the application: 111 The original and 3 copies of the completed, dated

Article 12 Certificate (Agricultural Holdings):

vy. 0.y 1,4-c_e_A_ \f-c-f

c-eAvv-ii-e-dt Ao (,;34-0 Ad /co rivN $ Date, 2012-07-17 PS $Revision: 4636 S

27. 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.

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

(date cannot be

pre-application)

28. Applicant Contact Details

Telephone numbers

Country code: National number:

Country code: Mobile number (opti n

Country code: Fax number (optional):

Email address (optional):

Extension

number:

29. Agent Contact Details

Telephone numbers

Country code: National number:

Country code:

Country code:

gS V\

Mobile number (optional):

Fax number (optional):

Email address (optional):

Extension

number:

30. Site Visit

Can the site be seen from a public road, public footpath, bridleway 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 o I I Agent

If Other has been selected, please provide: Os'

Contact name: Telephone number:

1-4—Yes

Email address:

pplicant

fl No

Other (if different from the

agent/applicant's details)

$Dat, 2012-07-17 O S $Revision:4636 $