HSC FORM
1
Planning Act (Northern Ireland) 2011, section 109(2)
The Planning (Hazardous Substances) (No.2) Regulations (Northern Ireland)
2015, (Regulation 7)
Please note that when you submit a planning application the information, including plans, maps and
drawings, will appear on the Planning Register which is publicly available and, along with other
associated documentation (with the exception of personal telephone numbers, email addresses or
sensitive personal data), will also be published on the internet on the Public Access site
(www.planningni.gov.uk/public-access-info
). The Department for Infrastructure and the 11 Councils
will process your information in line with the General Data Protection Regulations (GDPR)
requirements. A copy of the full Privacy Statement is available at
www.infrastructure-ni.gov.uk/dfi-
privacy. To request a hard copy, please contact the relevant Data Protection Officer as listed in the
statement.
Certificate A
I hereby certify that the accompanying application / appeal* is made on behalf of
__________________________________________ (Name of applicant/appellant*) who is in actual
possession of every part of the land to which the said application/appeal* relates and is entitled to a
fee simple absolute/a fee tail/a life estate/a tenancy of which at least 40 years remain unexpired in
the land*.
OR
Certificate B
I hereby certify that the accompanying application / appeal* is made on behalf of
___________________________________________ (Name of applicant/appellant*) who is the
trustee of a trust or settlement which effects every part of the land to which the said application /
appeal* relates, and that at the date of application / appeal*:
(a) A beneficiary under the trust or settlement is in actual possession of every part of the land;
and
(b) no person other than a beneficiary under the trust or settlement is entitled to enter into the
actual possession of any part of the said land within the period of 40 years.
OR
Certificate C
I hereby certify that the requisite notice of the accompanying application / appeal* is made on
behalf of ______________________________________________ (Name of applicant/appellant*)
to any person who, at the beginning of the period of 21 days ending with the date of the said
application / appeal* was, in relation to all or any part of the land affected by the application /
appeal*:
(a) a person in actual possession;
(b) the trustee of a trust or settlement where the beneficiary under the trust or settlement was
in actual possession and no other person other than such a beneficiary was entitled to enter
into actual possession within a period of 40 years.
(c) A person (not being a person falling within (a) or (b)) entitled to enter into actual possession
within a period of 40 years
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Hazardous Substances Consent Form 3 is an additional form and should be completed in conjunction with the
P1 form (application for permission to develop land).
Official Use
Application No._________________
The persons upon whom notice was served are: (continue on a separate sheet if necessary)
Name and Address Interest Date of service of notice
_____________________________ _______________________ ___________________
_____________________________ _______________________ ___________________
_____________________________ _______________________ ___________________
_____________________________ _______________________ ___________________
OR
Certificate D
1. I hereby certify that the person making the accompanying application / appeal*:
(a) is unable to issue either Certificate A or B;
(b) has made due enquiries and is of the opinion that he / she is unable to issue a certificate for
the following reason:
(c) has given the requisite notice of the said application / appeal* to the under mentioned
persons who, at the beginning of the period of 21 days ending with the date of said
application / appeal*, were in the actual possession of all or part of the land to which the
application relates, namely:
Name and Address Date of service of notice
____________________________________________________ ___________________
____________________________________________________ ___________________
____________________________________________________ ___________________
2. Notice of the application / appeal* has been published in the:
_________________________________________ (title of newspaper) on
_________________________________________ (date of publication) and a copy of the
newspaper in which the notice appeared is enclosed.
Signature of Applicant or Agent: ________________________________________
Date: ________________________
*delete as appropriate
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signature
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