Application to modify or discharge a planning obligation
agreed under S106 of the Town and Country Planning Act 1990
Town and Country Planning (Modification and Discharge of Planning Obligations) Regulations 1992
Easting:
Description:
Northing:
Description of location or a grid reference.
(must be completed if postcode is not known):
3. Site Location Details
Please provide the full postal address or location of the
site to
which this application relates:
Address:
Officer name:
1. Applicant Name and Address
Title:
First name:
Phone
No:
Mobile
No:
Email:
2. Agent Name and Address
First name:
4. Pre-application Advice
Have you received pre-application advice about this
application?
Yes
No
Reference:
Date (DD/MM/YYYY):
Details of pre-application advice received:
5. Authority Member/Employee
Yes
Are you a member of staff, an elected member,
related to a member of staff or related to an
elected member of the LDNPA?
No
If Yes, please provide details of the name, relationship
and role
Phone
No:
Mobile
No:
Email:
Title:
Last
name:
Address:
Planning Application Reference No:
7. Details of the Modification/Discharges Sought
Please provide details of the modification/discharges sought under this application, including reasons why these changes are
proposed (you can append any additional related information to this application form):
Please provide sufficient information to enable the Authority to identify the planning obligation to which this application
relates:
Planning Obligation/S106 Reference No:
Date of Decision:
Date of Agreement:
Any other information necessary to identify the planning obligation to which this application relates:
6.
Details of the Planning Obligation to which this application relates
8. Certificates
You must complete one of the following certificates:
Signed:
Certificate A
I certify that on the day 21 days before the date of the accompanying application, the planning obligation to which
the application relates was enforceable against nobody other than the applicant.
Signed: Date (DD/MM/YYYY):
Certificate B
I certify that the applicant has given notice to everyone else against whom, on the day 21 days before the date of
the accompanying application, the planning obligation to which the application relates was enforceable, as listed
below.
Person on whom notice
was served
Address at which notice was served
Date on which notice
was served
Signed: Date (DD/MM/YYYY):
Certificate C
I certify that:
(a) The applicant cannot issue a Certificate A or B in respect of the accompanying application;
(b) The applicant has given notice to the persons listed below, being persons against whom, on the day 21 days
before the date of the application, the planning obligation to which the application relates was enforceable
Person on whom notice
was served
Address at which notice was served
Date on which notice
was served
(c) The applicant has taken reasonable steps to ascertain the name and address of every person against whom, on the
day 21 days before the date of the application, the planning obligation to which the application relates was
enforceable and who has been given notice of the application but has been unable to do so. These steps were as
follows:
(d) Notice of the application, as attached to this certificate, has been published as follows [newspaper and date]:
Signed: Date (DD/MM/YYYY):
9. Declaration
I hereby confirm that I am the person against whom the planning obligation of which
we seek modification/discharge is enforceable, and the information contained in this
application is, to the best of my knowledge, accurate.
Date (DD/MM/YYYY):
10.
Checklist
Completed application form:
Map identifying the land to
which the obligation relates:
Any other relevant
information:
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