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Application for Planning Permission and conservation
area consent for demolition in a conservation area.
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: 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:
3. Description of the Proposal
Please provide a description of the proposal, including details of the proposed demolition:
Has the building, work or
change of use already started?
NoYes
If Yes, please state the date when building,
works or use were started (DD/MM/YYYY):
(date must be pre-application submission)
Has the building, work or
change of use been completed?
NoYes
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)
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4. 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:
5. 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?
Is a new or altered vehicle access
proposed to or from the public highway?
Yes
No
Is a new or altered pedestrian access
proposed to or from the public highway?
Yes No
Are there any new public
roads to be provided within the site?
Yes No
Are there any new public rights of way to
be provided within or adjacent to the site?
NoYes
Do the proposals require any
diversions /extinguishments
and/or creation of rights of way?
NoYes
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)
6. Pedestrian and Vehicle Access, Roads and Rights of Way
7. Waste Storage and Collection
Do the plans incorporate areas to store
and aid the collection of waste?
Yes No
If Yes, please provide details:
Have arrangements been made for the separate
storage and collection of recyclable waste?
Yes No
If Yes, please provide details:
Have you consulted your neighbours or
the local community about the proposal?
Yes No
If Yes, please provide details:
8. Neighbour and Community Consultation
9. 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
Yes No
If Yes, please provide details of the name, relationship and role
Do any of these
statements apply to you?
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10. Explanation for Proposed Demolition Work
Why is it necessary to demolish all or part of the building(s) and/or structure(s)?
11. Materials
If applicable, please state what materials are to be used externally. Include type, colour and name for each material:
Existing
(where applicable)
Proposed
Not
applicable
Don't
Know
Walls
Roof
Windows
Doors
Boundary treatments
(e.g. fences, walls)
Vehicle access and
hard-standing
Lighting
Others
(please specify)
Are you supplying additional information on submitted plan(s)/drawing(s)/design and access statement?
Yes No
If Yes, please state references for the plan(s)/drawing(s)/design and access statement:
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12. Vehicle Parking
Please provide information on the existing and proposed number of on-site parking spaces:
Type of Vehicle
Total
Existing
Total proposed (including
spaces retained)
Difference
in spaces
Cars
Light goods vehicles/
public carrier vehicles
Motorcycles
Disability spaces
Cycle spaces
Other (e.g. Bus)
Other (e.g. Bus)
13. Trees and Hedges
Yes No
Yes No
Are there trees or hedges on the
proposed development site?
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?
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
design, demolition and construction - Recommendations'.
No
Yes
14. Trade Effluent
Does the proposal involve the need to
dispose of trade effluents or waste?
If Yes, please describe the nature, volume and means of disposal
of trade effluents or waste
16. Related Proposals
Are there any current applications, previous
proposals or demolitions for the site?
NoYes
If Yes please describe and include the planning application
reference number(s), if known:
Description
Reference
number
15. Foul Sewage
Please state how foul sewage is to be disposed of:
Mains sewer
Septic tank
Package treatment plant
Cess pit
Other
Are you proposing to connect
to the existing drainage system?
NoYes
If Yes, please include the details of the existing system on the
application drawings and state references for the plan(s)/drawing(s):
17. Biodiversity and Geological Conservation
To assist in answering the following questions refer to the guidance notes on the Planning Portal website (see “Local level requirements
and additional documentation”). The notes provide 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?
Yes, on the development site
Yes, on land adjacent to or near the
proposed development
No
b) Designated sites, important habitats or
other biodiversity features:
Yes, on the development site
Yes, on land adjacent to or near the
proposed development
No
c) Features of geological conservation
importance:
Yes, on the development site
Yes, on land adjacent to or near the
proposed development
No
a) Protected and priority species:
Supporting Information Requirements
Where a development proposal is likely to affect features of biodiversity or geological conservation interest, you will need to submit, with
the application, sufficient information and assessments to allow the local planning authority to determine the 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.
Your Local Planning Authority will be able to advise on the content of any assessments that may be required.
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18. Residential Units (Including Conversion)
Does your proposal include the gain, loss or change of use of residential units?
If Yes, please complete details of the changes in the tables below:
Yes No
TOTAL NET GAIN or LOSS of RESIDENTIAL UNITS (Proposed Housing Grand Total - Existing Housing Grand Total):
Market
Housing
Not
known
Number of Bedrooms
Total
1 2 3 4+ Unknown
Houses a
Flats and maisonettes b
Live-work units c
Cluster flats d
Sheltered housing e
Bedsit/studios f
Unknown type g
Totals (a + b + c + d + e + f + g) = A
Social Rented
Not
known
Number of Bedrooms
Total
1 2 3 4+ Unknown
Houses a
Flats and maisonettes b
Live-work units c
Cluster flats d
Sheltered housing e
Bedsit/studios f
Unknown type g
Totals (a + b + c + d + e + f + g) = B
Intermediate
Not
known
Number of Bedrooms
Total
1 2 3 4+ Unknown
Houses a
Flats and maisonettes b
Live-work units c
Cluster flats d
Sheltered housing e
Bedsit/studios f
Unknown type g
Totals (a + b + c + d + e + f + g) = C
Key worker
Not
known
Number of Bedrooms
Total
1 2 3 4+ Unknown
Houses a
Flats and maisonettes b
Live-work units c
Cluster flats d
Sheltered housing e
Bedsit/studios f
Unknown type g
Totals (a + b + c + d + e + f + g) = D
Total proposed residential units (A + B + C + D) =
Proposed Housing
Market
Housing
Not
known
Number of Bedrooms Total
1 2 3 4+ Unknown
Houses a
Flats and maisonettes b
Live-work units c
Cluster flats d
Sheltered housing e
Bedsit/studios f
Unknown type g
Totals (a + b + c + d + e + f + g) = E
Social Rented
Not
known
Number of Bedrooms
Total
1 2 3 4+ Unknown
Houses a
Flats and maisonettes b
Live-work units c
Cluster flats d
Sheltered housing e
Bedsit/studios f
Unknown type g
Totals (a + b + c + d + e + f + g) = F
Intermediate
Not
known
Number of Bedrooms
Total
1 2 3 4+ Unknown
Houses a
Flats and maisonettes b
Live-work units c
Cluster flats d
Sheltered housing e
Bedsit/studios f
Unknown type g
Totals (a + b + c + d + e + f + g) = G
Key worker
Not
known
Number of Bedrooms
Total
1 2 3 4+ Unknown
Houses a
Flats and maisonettes b
Live-work units c
Cluster flats d
Sheltered housing e
Bedsit/studios f
Unknown type g
Totals (a + b + c + d + e + f + g) = H
Total existing residential units (E + F + G + H) =
Existing Housing
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19. All Types of Development: Non-residential Floorspace
Does your proposal involve the loss, gain or change of use of non-residential floorspace?
Yes No
If you have answered Yes to the question above please add details in the following table:
Use class/type of use
Not
applicable
Existing gross
internal
floorspace
(square metres)
Gross internal floorspace
to be lost by change of
use or demolition
(square metres)
Total gross internal
floorspace proposed
(including change of
use)(square metres)
Net additional gross
internal floorspace
following development
(square metres)
A1 Shops
Net tradable area:
A2
Financial and
professional services
A3 Restaurants and cafes
B1 (a) Offices
B1 (b)
Research and
development
B1 (c) Light industrial
B2 General industrial
B8 Storage or distribution
C1
Hotels and halls of
residence
C2 Residential institutions
D1
Non-residential
institutions
D2 Assembly and leisure
OTHER
Please
Specify
Total
In addition, for hotels, residential institutions and hostels, please additionally indicate the loss or gain of rooms
Use
class
Type of use
Not
applicable
Existing rooms to be lost by change
of use or demolition
Total rooms proposed (including
changes of use)
Net additional rooms
C1 Hotels
C2
Residential
Institutions
OTHER
Please
Specify
20. Employment
Please complete the following information regarding employees:
Full-time Part-time Total full-time equivalent
Existing employees
Proposed employees
21. Hours of Opening
If known, please state the hours of opening (e.g. 15:30) for each non-residential use proposed:
Use Monday to Friday Saturday
Sunday and
Bank Holidays
Not known
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Please state the site area in hectares (ha)
22. Site Area
NoYes
Does your proposal involve the construction
of a new building which would result in the
loss or gain of public open space?
If Yes, please complete the following information regarding public
open space:
Open Space Lost Open space gained
Area of Land (ha)
23. Assessment of Flood Risk
Is the site within an area at risk of flooding? (Refer to the Welsh Government’s
Development Advice Maps website - http://data.wales.gov.uk/apps/floodmapping/)
Yes
No
If Yes, and you are proposing a new building or change of use, please add details of the proposal in the following table:
Floodplain Area Residential (Number of units) Non-residential (Area of land - hectares)
Floodplain C1
Floodplain C2
If the proposed development is within an area at risk of flooding you will need to consider whether it is appropriate to submit a flood
consequences assessment. (Refer to Section 6 and 7 and Appendix 1 of TAN 15 - http://wales.gov.uk/topics/planning/policy/tans/tan15/?
lang=en)
No
Yes
Will the proposal increase the flood risk elsewhere?
Is your proposal within 20 metres of a watercourse (e.g. river, stream or beck)?
How will surface water be disposed of?
Sustainable drainage system Soakaway Main sewer Existing watercourse Pond/lake
NoYes
24. Existing Use
Please describe the current use of the site:
Is the site currently vacant?
Yes No
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)
If you have answered Yes to any of the above, you will need to
submit an appropriate contamination assessment.
NoYes
Does your proposal involve the construction of a
new building?
If Yes, please complete the following information regarding the
element of the site area which is in previously developed land or
greenfield land:
Does the proposal involve any of the following:
Land which is known to be contaminated?
Yes No
Land where contamination is suspected for all
or part of the site?
Yes No
A proposed use that would be particularly
vulnerable to the presence of contamination?
Yes No
Previously
Developed Land
Greenfield
Land
Area of land (ha) proposed for
new development
25. Renewable and Low Carbon Energy
Does your proposal involve the installation of a stand-alone
renewable or low-carbon energy development?
Yes
No
If you have answered Yes to the question above please state the
proposed energy output capacity in MegaWatts (MW):
Renewable Energy Type Energy Capacity (MW)
Anaerobic digestion
Biofuels
Biomass
Combined heat and power (CHP)
District heating
Fuel cells
Geothermal
Ground/water/air heat pumps
Hydropower
Solar
Waste heat energy
Wind
Other low carbon or renewable
energy (please specify below)
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26. Industrial or Commercial Processes and Machinery
Not
applicable
The total capacity of the void in cubic metres,
including engineering surcharge and making no
allowance for cover or restoration material (or
tonnes if solid waste or litres if liquid waste)
Maximum annual operational
through put in tonnes
(or litres if liquid waste)
Inert landfill
Non-hazardous landfill
Hazardous landfill
Energy from waste incineration
Other incineration
Landfill gas generation plant
Pyrolysis/gasification
Metal recycling site
Transfer stations
Material recovery/recycling facilities (MRFs)
Household civic amenity sites
Open windrow composting
In-vessel composting
Anaerobic digestion
Any combined mechanical, biological and/
or thermal treatment (MBT)
Sewage treatment works
Other treatment
Recycling facilities construction, demolition
and excavation waste
Storage of waste
Other waste management
Other developments
Please describe the activities and processes which would
be carried out on the site and the end products including
plant, ventilation or air conditioning. Please include the
type of machinery which may be installed on site:
If the answer is Yes, please complete the following table:
Is the proposal a waste management development?
Yes
No
Please provide the maximum annual operational throughput of the following waste streams:
Municipal
Construction, demolition and excavation
Commercial and industrial
Hazardous
If this is a landfill application you will need to provide further information before your application can be determined. Your waste
planning authority should make clear what information it requires on its website.
27. Hazardous Substances
Does the proposal involve the use or storage of any of
the following materials in the quantities stated below?
If Yes, please provide the amount of each substance that is involved:
No
Not applicable
Yes
Acrylonitrile (tonnes)
Ammonia (tonnes)
Bromine (tonnes)
Chlorine (tonnes)
Ethylene oxide (tonnes)
Hydrogen cyanide (tonnes)
Liquid oxygen (tonnes)
Liquid petroleum gas (tonnes)
Phosgene (tonnes)
Sulphur dioxide (tonnes)
Flour (tonnes)
Refined white sugar (tonnes)
Other: Other:
Amount (tonnes): Amount (tonnes):
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28. Ownership Certificates
One certificate A, B, C, or D must be completed, together with the Agricultural Holdings Certificate with this application form
Certificate Of Ownership - Certificate A
Certificate under Town and Country Planning (Development Management Procedure) (Wales) Order 2012 & Planning (Listed
Buildings and Conservation Areas) (Wales) Regulations 2012
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 (owner is a person with a freehold interest or leasehold interest with at least 7 years left to run) of any part of the land or building to
which the application relates.
Date (DD/MM/YYYY):
Or signed - Agent:Signed - Applicant:
Certificate Of Ownership - Certificate B
Certificate under the Town and Country Planning (Development Management Procedure) (Wales) Order 2012 & Planning (Listed
Buildings and Conservation Areas) (Wales) Regulations 2012
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 (owner is a person with a freehold interest or leasehold interest with at least 7 years
left to run) of any part of the land or building to which this application relates.
Name of Owner
Address
Date Notice Served
Date (DD/MM/YYYY):Or signed - Agent:Signed - Applicant:
Certificate Of Ownership - Certificate C
Certificate under the Town and Country Planning (Development Management Procedure) (Wales) Order 2012 & Planning (Listed
Buildings and Conservation Areas) (Wales) Regulations 2012
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 (owner is a person with a freehold
interest or leasehold interest with at least 7 years left to run) of the land or building, or of a part of it , but I have/ the applicant has
been unable to do so.
The steps taken were:
Name of Owner
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):
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28. Ownership Certificates (continued)
Certificate Of Ownership - Certificate D
Certificate under the Town and Country Planning (Development Management Procedure) (Wales) Order 2012 & Planning (Listed
Buildings and Conservation Areas) (Wales) Regulations 2012
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 (owner is a person with a freehold interest or leasehold interest with at least 7 years left to run)
of any part of the land to which this application relates, but I have/ the applicant has been unable to do so.
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:
Agricultural Holding Certificate
Town and Country Planning (Development Management Procedure) (Wales) Order 2012
Agricultural Land Declaration - You Must Complete Either A or B
(A) None of the land to which the application relates is, or is part of, an agricultural holding.
Name of Tenant
Address
Date Notice Served
Date (DD/MM/YYYY):Or signed - Agent:
Signed - Applicant:
Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):
(B) I have/ The applicant has given the requisite notice to every person other than myself/ the applicant who, on the day 21 days
before the date of this application, was a tenant of an agricultural holding on all or part of the land to which this application relates,
as listed below:
29. Agricultural Holdings
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The original and 3 copies of a completed and dated
application form:
The original and 3 copies of the plan which identifies
the land to which the application relates 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:
The correct fee:
The original and 3 copies of a design and access statement,
if required (see help text and guidance notes for details):
The original and 3 copies of the completed, dated
Ownership Certificate (A, B, C, or D - as applicable):
The original and 3 copies of the completed, dated
Article 11 Certificate (Agricultural Holdings):
Depending on the type and scale of proposed development, your application – in order to be validated - may also need to be
accompanied by the following technical documents:
- Flood Consequences Assessment
- Biodiversity and Geological Conservation Assessment
- Tree Survey
- Coal Mining Risk Assessment
- Rural Enterprise Dwelling Appraisal
- Retail Impact Assessment
- Noise Assessment
- Transport Assessment
The guidance note available on the Planning Portal website (see “Local level requirements and additional documentation”) and Welsh
Government Circular 002/2012 will assist you in determining whether any of these assessments are necessary.
You should also note that your Local Planning Authority may have adopted ‘Local Validation Requirements’ for some major developments.
Information on any “Local Validation Requirements” will be available on the Local Planning Authority’s website.
30. 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.
31. Declaration
I/we hereby apply for planning permission as described in this form and the accompanying plans/drawings and additional information. I
confirm that, to the best of my knowledge, any facts stated are true and accurate and any opinions given are the genuine opinions of the
persons giving them.
Or signed - Agent:Signed - Applicant: Date (DD/MM/YYYY):
(date cannot be
pre-application)
32. Applicant Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
33. Agent Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
34. 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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