$Date:: 2015-05-19 #$ $Revision: 6174 $
Application for prior notification of proposed development by
telecommunications code system operators.
Town and Country Planning General Permitted Development Order 2015 Schedule 2, Part 16
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: First name:
Last name:
Address 1:
Address 2:
Town:
Address 3:
County:
Country:
Postcode:
Company
(optional):
House
number:
House
name:
House
suffix:
Unit:
2. Agent Name and Address
Title:
House
name:
House
suffix:
House
number:
Unit:
Company
(optional):
First name:
Last name:
Address 1:
Address 2:
Town:
Address 3:
County:
Country:
Postcode:
$Date:: 2015-05-19 #$ $Revision: 6174 $
4. Pre-application Advice
Has assistance or prior advice been sought from the local
authority about this application?
NoYes
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:
Officer name:
Reference:
Date: (DD/MM/YYYY)
(must be pre-application submission)
Details of pre-application advice received?
5. Telecommunications Apparatus
Please specify the type of apparatus to be installed or altered (e.g. call box, mast):
Are you replacing an existing installation?
Yes No
Please provide further details of the apparatus (e.g. height, size, colour, etc):
If Yes, please provide further details of the existing apparatus (e.g. height, size, colour etc):
Are you submitting a declaration confirming that the apparatus is in full compliance with
the requirements of the radio frequency (RF) public exposure guidelines of the
International Commission on Non-Ionizing Radiation Protection (ICNIRP)? The emissions
from all mobile phone network operators' equipment on the site must be taken into
account when determining compliance.
Yes
No
Are you also providing a completed Supplementary Information
Template (as set out in Appendix E of the Code of Best Practice on
Mobile Phone Network Development)?
Yes No
6. Supplementary Information
Have you consulted your neighbours or
the local community about the proposal?
Yes No
If Yes, please provide details:
7. Neighbour and Community Consultation
3. Site Address Details
Please provide the full postal address of the application site.
House
name:
House
suffix:
House
number:
Unit:
Address 1:
Address 2:
Town:
Address 3:
County:
Postcode
(optional):
Easting: Northing:
Description of location or a grid reference.
(must be completed if postcode is not known):
Description:
$Date:: 2015-05-19 #$ $Revision: 6174 $
8. Planning Application Requirements - Checklist
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 has been submitted.
The original and 3 copies of a completed and dated prior notification form:
The original and 3 copies of the location plan to a scale not less than 1:2500:
The correct fee:
9. 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.
Or signed - Agent:Signed - Applicant:
Date (DD/MM/YYYY):
(date cannot be pre-application)
10. Applicant Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
11. Agent Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
12. Site Visit
Can the site be seen from a public road, public footpath, bridleway or other public land?
No
Yes
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)
ApplicantAgent
If Other has been selected, please provide:
Contact name: Telephone number:
Email address:
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