1. Applicant Name and Address 2. Agent Name and Address
Title: Title:First name: First name:
Last name: Last name:
Company
(optional):
Company
(optional):
Unit: Unit:
House
number:
House
number:
House
sufx:
House
sufx:
House
name:
House
name:
Address 1: Address 1:
Address 2: Address 2:
Address 3: Address 3:
Town: Town:
County: County:
Country: Country:
Postcode: Postcode:
Application for Consent fo
r Works to Protected Trees
(in compliance with)
The Planning (Trees) Regulations (Northern Ireland) 2015
Please complete using block capitals and black ink.
You must use this form if you are applying for work to trees protected by a tree preservation order (TPO). (You may also
use it to give notice of works to trees in a conservation area).
It is important that you read the accompanying guidance notes before lling in the form. Without the correct information,
your application/notice cannot proceed.
3. Trees Location
6. Tree Preservation Order Details
4. Trees Ownership
Title: First name:
Last name:
Company
(optional):
Unit:
Unit:
House
number:
House
number:
House
sufx:
House
sufx:
House
name:
House
name:
Address 1:
Address 1:
Address 2:
Address 2:
Address 3:
Address 3:
Town:
Town:
County:
County:
Postcode:
Postcode:
Area code: Telephone number:
Mobile number (optional):
Fax number (optional):
If all trees stand at the address shown in Question 1, go to
Question 4. Otherwise, please provide the full address/location
of the site where the tree(s) stand (including full postcode where
available)
Yes No
Yes No
Yes No
If the location is unclear or there is not a full postal address, either
describe as clearly as possible where it is (for example, ‘Land to
the rear of 12 to 18 High Street’ or ‘Woodland adjoining Elm Road’)
or provide an Ordnance Survey grid reference:
Description:
If all trees stand at the address shown in Question 1, go to
Question 4. Otherwise, please provide the full address/location
of the site where the tree(s) stand (including full postcode where
available)
Is the applicant the owner of the tree(s):
If ‘No’ please provide the address of the
owner (if known and if different from the
trees location)
Yes No
5. What Are You Applying For?
Are you seeking consent for works to tree(s)
subject to a TPO?
Are you seeking consent for works to tree(s)
covered by a planning condition?
Are you wishing to carry out works to tree(s)
in a conservation area?
7. Identification of Tree(s) and Description of Works
Please identify the tree(s) and provide a full and clear specication of the works you want to carry out. Continue on a separate sheet if
necessary. You might nd it useful to contact an arborist (tree surgeon) for help with dening appropriate work. Where trees are protected
by a TPO, please number them as shown in the First Schedule to the TPO where this is available. Use the same numbers on your sketch
plan (see guidance notes).
Please provide the following information below: tree species (and the number used on the sketch plan) and description of works. Where
trees are protected by a TPO you must provide reasons for the work and, if you are requesting removal of the tree(s), please give your
proposals for planting replacement trees (including quantity, species, position and size).
continued overleaf...
7. Identification of Tree(s) and Description of Works ...continued
8. Trees - Additional Information
Additional information may be attached to electr
onic communications or provided separately in paper format.
For all trees
A sketch plan clearly showing the position of trees listed in Question 7 must be provided when applying for works to trees covered by
a TPO. A sketch plan is also advised when notifying the Council of works to trees in a conservation area (see guidance notes).
For works to trees covered by a TPO
Please indicate whether the reasons for carrying out the proposed works include any of the following. If so, your application must be
accompanied by the necessary evidence to support your proposals. (See guidance notes for further details)
1. Health/Condition of the tree(s) - e.g. it is diseased or you have fears that it might break or fall:
If YES, you are required to provide written arboricultural advice or other diagnostic information
from an appropriate expert.
2. Alleged damage to property - e.g. subsidence or damage to drains or drives.
If YES, you are required to provide for:
Subsidence
A report by an engineer or surveyor, to include a description of damage, vegetation, monitoring data, soil, roots and repair
proposals. Also a report from an arboriculturist to support the tree work proposals.
Other structural damage (e.g. drains, walls and hard surfaces)
Written technical evidence from an appropriate expert, including description of damage and possible solutions.
Documents and plans (for any tree)
Are you providing separate information (e.g. an additional schedule of work for Question 7)?
If YES, please provide the reference numbers of plans, documents, professional reports, photographs etc in support of your application.
If they are being provided separately from this form, please detail how they are being submitted.
Yes
Yes
Yes
No
No
No
10. Application For Tree Works - Checklist
11. Declaration - Trees
12. Applicant Contact Details
Only one copy of the application form and additional information (Question 8) is required. Please use the guidance and this checklist to
make sure that this form has been completed correctly and that all relevant information is submitted. Please note that failure to supply
precise and detailed information may result in your application being rejected or delayed. You do not need to ll out this section, but it may
help you to submit a valid form.
Sketch Plan
• A sketch plan (to scale) showing the location of all trees. (see Question 8)
For all trees (see Question 7)
• Clear identication of the trees concerned.
• A full and clear specication of the works to be carried out.
For works to trees protected by a TPO (see Question 7)
Have you:
• stated reasons for the proposed works?
• provided evidence in support of the stated reasons? In particular:
if your reasons relate to the condition of the tree(s) - written evidence
from an appropriate expert.
if you are alleging subsidence damage - a report by an appropriate
engineer or surveyor and one from an arboriculturist.
in respect of other structural damage - written technical evidence.
• included all other information listed in Question 8?
I/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional
information. I/we conrm 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.
Signed - Applicant: Or signed - Agent:
Date (DD/MM/YYYY):
(This date must not be before the date of
sending or hand-delivery of the form)
Electronic communication - If you submit this form by fax or e-mail the Council may communicate with you in the same manner. (Please see guidance notes)
Lisburn & Castlereagh City Council
Planning Section
Civic Headquarters
Lagan Valley Island
Lisburn
BT27 4RL
Tel: 028 9250 9250
Email: planning@lisburncastlereagh.gov.uk
9. Council Employee / Elected Member
With respect to the Council, I am:
(a) a member of staff (b) an elected member (c) related to a member of staff (d) related to an elected member
Do any of these statements apply to you?
Yes
If Yes, please provide details of the name, relationship and role
No
Area code: Telephone number:
Mobile number (optional):
Email address (optional):
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