$Date:: 2014-02-10 #$ $Revision: 5975 $
10. Certificates (continued)
Certificate Of Ownership - Certificate D
Certificate under the 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.
The steps taken were:
On the following date (which must not be earlier
than 21 days before the date of the application):
Notice of the application has been published in the following newspaper
(circulating in the area where the land is situated):
Date DD/MM/YYYY):Or signed - Agent:Signed - Applicant:
12. 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)
13. Applicant Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
14. Agent Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
15. 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:
11. 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 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:
The original and 3 copies of the completed dated
Ownership Certificate (A, B, C, or D - as applicable):
