Form PHD
Planning Application
Householder Development
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 Planning Portal (
This form is to be used for applications for full planning permission for works of alteration/extension to a dwelling or
other development for domestic purposes within the curtilage of a dwelling (e.g. erection of a garage).
5 copies of this form and 5 copies of related plans (site layout/block plans not less than 1:500 scale, floor plans and
elevations not less than 1:100 scale) must be submitted. 5 copies of location plans (preferably Ordnance Survey)
not less than 1:2500 showing the site outlined in red must also be submitted.
Please complete all sections in BLOCK LETTERS
Section A
Applicant’s name and address Agent’s name and address (if applicable)
Name: Name:
Address: Address:
Town: Town:
Postcode: Postcode:
Tel: Tel:
Ref. No.:
Section B
Full postal address of
Property to which the
application relates
Please give a brief description of the proposed building works
(e.g. 2 storey side extension to dwelling to allow garage on ground floor with 2 bedrooms above.)
Section C
Access to roads (please tick)
Will there be a new access or any alteration to an existing access to a public road?
Yes No
If ‘Yes’ details should be included in the plans
Drainage (please tick)
Does the proposal involve the installation of a septic tank? Yes No
If ‘Yes’ details should be included in the plans
Official Use
Application No. _________________
Fee Received £____________________
Receipt No.
Section D
Council Employee / Elected Member Interest
Are you / the applicant / applicant’s spouse or partner, a member of staff within the council or an elected member of
the council?
Yes No
Or are you / the applicant / the applicant’s spouse or partner, a relative of a member of staff in the council or an
elected member of the council or their spouse or partner?
Yes No
If you have answered yes please provide details (name, relationship and role):
Section E
Section 42 of the Planning Act (Northern Ireland) 2011 requires each planning application to be accompanied by a
certificate of ownership. If the certificate below does not apply because you do not own, or have a long lease of the
application site, your local Area Planning Office can provide an alternative form of certificate which must be
completed before your application can be considered. I hereby certify that this application is made by or on behalf of
(Please use BLOCK LETTERS)
who is in actual possession of every part of the land to which the said application relates and is entitled to:
*a fee simple absolute/ a life estate/ a tenancy of which at least 40 years remain unexpired in the land.
must delete words which do not apply)
Signature of applicant/agent__________________________________ Date_____________________
It is an offence to make a false or misleading statement
click to sign
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Section F
Statutory Neighbour Notification of an application for planning permission
Please read the “Notes for Applicants” on the next page before completing this section
This form is part of your planning application. If you do not supply all the necessary details your application
will be incomplete and it will be returned to you.
You are not required to notify the identified occupiers listed below. This will be done by the Council, or as
the case may be, the Department of the Environment.
Please give the address of any identified occupiers on neighbouring land. (Where identified occupiers of a building
have to be notified and the building is in multiple occupation give the address of all occupiers)
a) Address: b) Address:
Town: Town:
Postcode: Postcode:
c) Address: d) Address:
Town: Town:
Postcode: Postcode:
e) Address: f) Address:
Town: Town:
Postcode: Postcode:
g) Address: h) Address:
Town: Town:
Postcode: Postcode:
If there is not enough space please list any additional addresses on a separate sheet.
Section G
I/We hereby apply for planning permission to carry out the development described in this application and the
accompanying plans.
I enclose a cheque/postal order no. _____________________ for the sum of £ _______________
Cheques or postal orders should be made payable to the relevant Council, or as the case may be, the Department
of the Environment (‘DOE General Account’) and crossed ‘Not negotiable, A/C Payee only’.
Signed ______________________________________ Date ____________________
On behalf of (if applicable) _________________________________________________
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Statutory Neighbour Notification
Notes for Applicants
Please read these notes before filling in Section E
What is statutory Neighbour Notification?
Article 8 of the Planning (General Development Procedure) Order (Northern Ireland) 2015 requires the Council, or
as the case may be, the Department of the Environment (the Department) on receipt of an application for planning
permission to notify identified occupiers of buildings on neighbouring land adjoining the application site:
a. that an application for planning permission has been received and
b. where the application and related plans may be inspected
Owners not in occupation or persons with other interests in the land will not be notified.
What should you do now?
To help the Council, or as the case may be, the Department to make the notifications about your application, please
list in the section opposite the addresses of identified occupiers of “neighbouring land”.
What is “neighbouring land”?
Neighbouring land means land which directly adjoins the application site, or which would adjoin it but for an entry or
road less than 20 metres in width.
Which neighbours are “identified occupiers”?
An identified occupier is the occupier of premises within a 90 metre radius of the boundary of the proposed
application site. It is therefore the addresses of these buildings only that you should enter.
If your application relates to a building in multiple occupation e.g. a block of flats, you should also list the addresses
of the units above and/or below the application site.
Further Information
If you have any difficulty in completing this form please do not hesitate to contact your local planning office.
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