$Date:: 2015-05-19 #$ $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: