$Date:: 2014-02-10 #$ $Revision: 5975 $
9. Authority Employee / Member
With respect to the Authority, I am:
(a) a member of staff (c) related to a member of staff
(b) an elected member (d) related to an elected member
Yes No
If Yes, please provide details of the name, relationship and role
Do any of these statements apply to you?
10. Application For Tree Works - Checklist
Only one copy of the application form and additional information (Question 8) is required. Please use the guidance and this checklist to
make sure that this form has been completed correctly and that all relevant information is submitted. Please note that failure to
supply precise and detailed information may result in your application being rejected or delayed. You do not need to fill out this section,
but it may help you to submit a valid form.
Sketch Plan
A sketch plan showing the location of all trees (see Question 8)
For all trees
(see Question 7)
Clear identification of the trees concerned
A full and clear specification of the works to be carried out
For works to trees protected by a TPO
(see Question 7)
Have you:
stated reasons for the proposed works?
provided evidence in support of the stated reasons? in particular:
if your reasons relate to the condition of the tree(s) - written evidence from an
appropriate expert
if you are alleging subsidence damage - a report by an appropriate engineer or surveyor
and one from an arboriculturist.
in respect of other structural damage - written technical evidence
included all other information listed in Question 8?
11. Declaration - Trees
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):
(This date must not be before the date
of sending or hand-delivery of the form)
12. Applicant Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
13. Agent Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
Electronic communication - If you submit this form by fax or e-mail the LPA may communicate with you in the same manner.
(Please see guidance notes)