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Town and Country Planning Act 1990
Planning (Listed Buildings and Conservation Areas) Act 1990
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:
Application for a new planning permission to replace an extant planning permission,
in order to extend the time limit for implementation.
Application for replacement of associated listed building and/or conservation area consents in
order to extend the time limit for implementation.
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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 of advice (DD/MM/YYYY):
Details of pre-application advice received:
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:
If you have answered No to this question, you cannot apply to replace this planning permission.
No
Yes
Was the existing planning permission extant on 1 October 2010?
5. Eligibility
If you are applying to replace an existing listed building or conservation area consent, is it
associated with a planning permission which you are also applying to replace?
NoYes
If you have answered No to this question you cannot apply to replace this listed building consent or
conservation area consent.
No
Yes
If you have answered No to this question you cannot apply to replace this listed building consent or
conservation area consent.
6. Description Of Your Proposal
Please provide a description of the approved development as shown on the decision letter, including application reference number and
date of decision in the sections below. Please also provide the original application type:
Not Applicable
Not Applicable
If you are applying to replace a listed building or conservation area consent, was it extant
on 1 October 2010?
Date of decision (DD/MM/YYYY):Reference number:
What was the original application type?:
(e.g. ‘Full’, ‘Householder and Listed Building’, ‘Outline’)
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6. Description Of Your Proposal (continued)
Householder development: development to an existing dwellinghouse or development within its curtilage
b) Conservation area consent (if applicable):
Date of decision (DD/MM/YYYY):
Reference number:
Date of decision (DD/MM/YYYY):Reference number:
If you are also seeking to replace an associated a)listed building consent and/or a b)conservation area consent in order to extend the time
limit for their implementation, please also provide a description of the consented schemes, including the application reference numbers
and dates of decision:
a) Listed building consent (if applicable):
7. Authority Employee / Member
If yes please provide details of the name, relationship and role
Yes No
Do any of these statements apply to you?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
For the purpose of calculating fees, which of the following best describes your application for planning
permission?
Major development: typically consists of developments for waste, or more than 10 dwellings or a site larger than 0.5 ha,
or building(s) with a floor space of 1,000 sq m or more
Other: anything not covered by either of the above categories
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8. 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 &
Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990
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.
Date (DD/MM/YYYY):Or signed - Agent:Signed - Applicant:
CERTIFICATE OF OWNERSHIP - CERTIFICATE B
Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14 &
Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990
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
Name of Owner / Agricultural Tenant
Address
Date Notice Served
Date (DD/MM/YYYY):Or signed - Agent:
Signed - Applicant:
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8. Ownership Certificates and Agricultural Land Declaration (continued)
CERTIFICATE OF OWNERSHIP - CERTIFICATE D
Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14 &
Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990
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
Notice of the application has been published in the following newspaper
(circulating in the area where the land is situated):
The steps taken were:
On the following date (which must not be earlier
than 21 days before the date of the application):
Date (DD/MM/YYYY):Or signed - Agent:Signed - Applicant:
CERTIFICATE OF OWNERSHIP - CERTIFICATE C
Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14 &
Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990
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:
Name of Owner / Agricultural Tenant
Address
Date Notice Served
Notice of the application has been published in the following newspaper
(circulating in the area where the land is situated):
On the following date (which must not be earlier
than 21 days before the date of the application):
Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):
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 correct fee:
The original and 3 copies of a
completed and dated application form:
9. 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.
For applications to replace listed building or conservation area consents only:
The original and 3 copies of a plan which identifies the land to
which the application relates and drawn to an identified scale
and showing the direction of North:
The original and 3 copies of other plans and drawings or
information necessary to describe the subject of the
application:
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10. 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.
Date (DD/MM/YYYY):
Signed - Applicant:
Or signed - Agent:
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:
13. Site Visit
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
12. Agent Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
11. Applicant Contact Details
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