$Date:: 2012-07-17 #$ $Revision: 4636 $
Application for approval of details reserved by condition.
Town and Country Planning Act 1990
Planning (Listed Buildings and Conservation Areas) 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:
$Date:: 2012-07-17 #$ $Revision: 4636 $
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. Description Of Your Proposal
Please provide a description of the approved development as shown on the decision letter, including the application reference number
and date of decision in the sections below:
Reference number: Date of decision:
(Date must be pre-application
submission) (DD/MM/YYYY)
Has the development already started?
Yes No
If Yes, please state when the development started (DD/MM/YYYY):
(date must be pre-application
submission)
Has the development been completed?
Yes No
If Yes, please state when the development was completed (DD/MM/YYYY):
(date must be pre-application
submission)
Please state the condition number(s) to which this application relates:
1. 6.
2. 7.
3. 8.
4. 9.
5. 10.
6. Discharge Of Condition
Please provide a full description and/or list of the materials/details that are being submitted for approval:
7. Part Discharge Of Condition(s)
If Yes, please indicate which part of the condition your application relates to:
NoYes
Are you seeking to discharge only part of a condition?
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:
$Date:: 2012-07-17 #$ $Revision: 4636 $
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 application form:
The original and 3 copies of other plans and drawings
or information necessary to describe the subject of the application:
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: