10 e
Planning Services
Town Hall, The Boulevard
CRAWLEY
RH1O 1UZ
West Sussex,
t: 01293 438512
e: [email protected]
Householder Application for Planning Permission for works or extension to a dwelling.
Town and Country Planning Act 1990
Publication of planning applications on council w.bsltss
Please note that with the exception of applicant contact details and Certificates of Ownership, die Information provided on this
application form and In supporting documents may be published on the councils wubsite.
—
If you have provided any other Information as
of your applIcation which falls within the definition of personal data under the
Data Protection Act which you do not wish to be publishad on the councirs webslte please contact the coundls planning
department.
Please complete using block capItals and black
It
Is Important
Ink
that you read the accompanying guidance notes as Incorrect completion wIll delay the processing of your applIcatIon.
A1lt
Name ,incl Acid; ess
2.
IN itcs FIrst name:[
iastname:l WRYHEEk
Title:
1
I
(opdona:
House
numbec
House
name:
1:
I
2_A.
'T±]
[
I
I
ircíir
House
suffix:
Cz-OSE
otaw
000 &t
Ipucg',ZScr
House
Ic
I
Address 2:
I
Address 3:
number
u-I
...
C- (2
j
I
House
suffix:
1
cvnct,c
I
p,iva rnct
Address 3:
Town:
I
County:
f
CAk'ZE/
Town:
I
w6ir Suflhf
I
County:
I
Country:
3.
L
Address 1:
J
md Address
First flame:
UnIt:
House
name:
t47/&LL/
Address 2:
Postcode:
litle:
Compan
Unlt
N.mnit
Lastname:I
Company
(optional):
Address
Agent
L./6sr
W16/
Country:
lci'
Postcode
JRgio 3ACl
Description of Proposed Wot ks
Please describe the proposed wol*s:
t
F
2 iJ JAN 2009
SOME
2tUS116 I 523M $ ffieWW 159$
I
3.
Description of Proposed Works continued)
Has
the work already started?
If Yes, please
0
R'No
Yes
state when the work was started (DD/MM/YYm:
Has the work already been completed?
if Yes, please state when
4. Site Address
io
EYes
the wokwascompleted
(DO/MMMYYY):
Details
I
I
45
Address 1:
I
I
I
5.
Please provide the full postal address of the application site.
I
House
House
Unit
number
sufThc
I
House
flame:
1
I
I
4(Pz-i c4wr
I
I
I
Address 2:
Iid,tiiaii nil
(date must be pie-application submission)
(date must be pie-application submission)
e,½N,. kii,il5 tid
UIiJtits
"
Isa new or altered vehicle access
proposed to or from the public highway?
D
Isa new or altered pedestrian access
proposed to or from the public highway?
Q Yes
Do the proposals require any diversions,
extlnguishments and/or creation of public
rlghtsofway?
(o
[JYes
to any questions, please show details on your plans or
drawings and state the reference number(s) of the plan(s)/
drawing(s):
if Yes
Address 3:
Town:
County:
I
1
I
I
Postcode
(optional):
6. Pre
application Advice
Has assistance at prior advice been sought from the local
authotltyaboutthls application?
[JYes
..
['Pio
please complete the Slowing Inftrmatlon about the advice
you were given. (This will help the authority to deal with this
application mote efficiently).
Please tick if the Ml contact details are not
known, and then complete as much possible:
If Yes,
Officer
Trees and Hedges
Are there any trees or hedges on your own
property or on adjoining propertIes which
are within falling distance of your boundary?
7.
0
Yes
please markthelr position on a scaled
plan and state the reference number of any plans or drawlngs
If Yes,
D
name
Reference:
trees or hedges need
to be removed orpruned In
order to carry out your proposal?
Will any
Date (DO MM WY?):
(must be pie-application submission)
Derails of the pie-application advice received:
D Yes
please show on your plans which trees by giving them
numbers e.g. Ti, Ti etc. state the reference number of the plan(s)/
drawing(s) and indicate the scale.
If Yes,
PA
8.
Parking
—
—,
wur—wwt
an-.
nun me propuwu
exlstlngcarpaddngarrangements?
IfYes,pleasedescrlbe:
DYes
/
'P4o
Is
the applicant or a4ent related to lily member of staff or electjt
memberofthecountli?
EtL
ifYes,pleaseprcvld4del&,
•I.. .....DYesr)
"No
.
C&CVIi itani 1½l.,v ISt$
10.
Matericils
If appllcakle, please state what materials are to be used externally. include type, colour and name for each material:
ExI
(where applicable)
J
Proposed
41-i.
Drawing
references If
D D
Waifs
Roof
DcWt
ill
E
fl
$iJTflA/6
D E
Doors
Boundary treatments
(e.g. fences, walls)
Vehlde access and
hard-standing
E E
Ughting
(pleasespecify)
flTT
ti
LaS
.
0
Are you supplying additional Information on submitted plan(s)fdrawlng(sWdeslgn and ac4ess statement?
If Yes, please state references for the plan(s)/drawing(s)/designand access statement:
F.
L..J
TT
Yes
/
3'No
.
$. JIV16 152*M
$M'fl.a 15,1
11.
Certificates
.
c
this application fonn
.4 tog.dw lth S. Ag&StuwS lIJubp Csunc*
CWTWICATE
A
OWNNIP
CMTIFICME OF
Town and Coimty Ft--Mq (Gene'S Dad__.it Procedure) OS. ins Cuuthlats imdur AsIde 1
On. CirtMcat. A, R,C,.r D muM
b.
except inyself/ the applicant was the
I certify/The applicant certifies that on the day 21 days before the date of this appicadon nobody
to run) of any part of the land or building to
owner (owner is apenon uu4th a freehold Mtetestor leasehold Mterest with at least 7jns
wlwdi the application relates.
Date (DD/MWYYY'fl:
Or signed - Agent
Signed - Appl4cant:
M
wicMt
OMHW
- T1HCATh S
OF
Town and Coumby PlamSo (GeneS DS1.m.M Procedure) OSs.' 1195 CetMat. urde' AsIde 1
I certify/The applicant certifies that I have/the applicant has given the requisite notice to evetwne else (as listed below) who on the day
tWth a .dsold htterest or leasehold ktterest with at least 7 yeatS
21 days before the date of this application, was the owner (owner is a
pnn
kfttonjofanypartofthelandorbSthngtowhlchtNsappiQtIonSatet
Name of Owner
cr-a
/rcøgr
M'22.
z6 f,TcJ/(r
i'lr.
Date Notice Served
Address
z&/i/o9
Ct..oSE
z/i/o9
ct-nt
Signed-Applicant
i
Date (DO
S
T1FICATE OF OWNHIP - TWICA1E C
-d Procedure) OS. ins Cetifirate wider Ltd. 7
town and Coufly PSeing (GeneS t...r
certify/The applicant certifies that
I
•
Neither Certificate A or B can be issued for this application
MI reasonable steps have been taken to find out the names and addresses of the other owners (owner is a person with a freehold
Interest or leasehold Interest with at least 7yean left to sun) dthe land or building, orof a part of It. but I have/the applicant has
been unableto do so.
The stepstaken were:
•
Name of Owner
Date Notice Served
Address
j
..;
25
No& of the applic tion
Signed - Applicant
as been
puStshedfln the following n
Or signed -
JAN 2009
tr
I
Date (DD/MM/YYV'fl:
Agent
H__________________________
SCat
icsns
I
U331 $ sa..da, IM $
11.
Certificates (continued)
CMTW)CATE OF
•
.
I
•
—
øresin
I)
._.t - CERTUC&TE
dsr
sat
Town and Coiny Pinks,, (GeneS C
1995 Centifcats
Muds 7
Procedure)
The applicant certifies that
Certificate A cannot be issued for this appUcatlon
All reasonable steps have been taken to find out the names and addresses everyone else who on the day 21 days before the
date of this application was the owner (osw,erIs apesso,i with a freef,oklhverestorkasthold interest with otkost 7years kft to run)
of any part &the land to which this application relate% but I have! the applicant has been unable to do so.
it
•
The steps taken were:
Notice of the application has been published In the following newspaper
(drculatlng In the area where the land Is situated):
519 fled -
On the following date (which mug not be earlier
than 21 days before the date of the application):
Or signed - Agent
ApplICant
Date (DO/MW/WY):
II
II
fl*
AGMCULTURAI. HOLDINGS CERTiFICATE
ad Coin7 PlnMg (GuiseS Dnlt
Procudsn)Ot 1995 CslcgrlculturaI Land Declaration - You Must Complete Either A or B
(A) None of the land to which the application relates 1s or Is part of; an agricultural holding.
Signed - Applicant
Or signed - Agent
Town
und
Mild, 7
77
Date (DO/MMPtVYfl:
11
have/The applicant has given the requisite notice to every person other than rnyself/ the applicant who, on the day 21 days
before the date of this application, was a tenantof an agricultural holding on all or part of the land to which this application relates as listed below:
Name of Tenant
Date Notice Served
Address
B)
I
Or signed - Agent
SIgned * Applicant
Date (DD/MM,WYY):
ii
IPUmaisIu.nw3U1ImiTflTUkwiui.rnimnUlINIfl
Please read the following cheddist to make sure you have sent all the Information In support of your proposal. FaIlure
to submit all
information required wilt result in your application being deemed invalid. It will not be considi iff1I6timiT*itjiWo&viqijliWby
the Local Planning Authority has been submitted.
Theorlglnaland3coplesofa
Theoriginal and3coplesofa
1 ec&r&tftt
and access statement where
completed and dated application form:
M design
T e original aid3 c,cj!s gtjpq
proposed works fall within one of
The original and 3 copIes of a plan which
j.j
cç'cnpleted. dttdd Rttltlb 7ttttItIcate
the following designated areas:
identifies the land to which the application
(igncultural Holdings):
relates drawn to an Identified scale
soentlflc
interest
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:
13.
I
J
• Conservation area
• Area of outstanding natural beauty
• World Heritage Site
•The8roads
Tlteo4saland3c4lesofthe
c&npleMtedThQtS Ship Certificate
(&B,CorD -as applicable):
DecIarition
I/we hereby apply for planning permission/consent as described in this form and the accompanlng piansfdrawings and additional
information.
Date (DD/M
Signed-Applicant
Orsigned Ag
(datecannotbe
I
F
U
lOst 5fl635c2fl6$
I.ft
¶a$
(
14.
Applicant Contact Details
15.
Telephone numbers
Telephone numbers
Extension
Extension
County code:
I
National number
IIosz,;
,34-76lI
Countir code:
number
I
II
II
I
I
Fax number (optional):
ii
I
II
Mobile number (optional):
Country code:
I
5/t302
II
I
I
Fax number (optional):
Country code:
110,293
I
number
National number:
Country code:
Mobile number (optional):
Country code:
Aqent Contact Details
I
Email address (optional):
Email address (optional):
I
I
IBacie,C6;rca ,WOTMfl,Conl
I
16. Site Visit
Can the site be seen from a public road, public footpath. bdd$eway or other public land?
flfl)l
If the planning authority needs to make an apponm'.ent
out a site visit whom should they contact? (PIeosese!ecto$7tyOne)
If Other has been selected, please provide:
Contact namt
C]
Agent
C]
"Appllcant
No
different from the
0 agent/applIcants
Other (If
details)
Telephone number
I
I
I
F
2.
JAN
Wfl.fl
152t$5
$Oft I.!!
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