(2,(2.19_01+13-71P,AL

to

Borough Borough Council

\IVED

19 MAR 2013

..............

Planning Services

Town Hall, The Boulevard

CRAWLEY

West Sussex, RH10 lUZ

t: 01293 438512

development.control@crawlemov.uk

Householder Application for Planning Permission

for works or extension to a dwelling and listed building consent.

Town and Country Planning Act 1990

Planning (Listed Buildings and Conservation Areas) Act 1990

You can complete and submit this form electronically via the Planning Portal by visiting www.planningportal.gov.uk/apply

Publication of applications on planning authority websites

Please note that the information provided on this application form and in supporting documents may be published on the

Authority's website. If you require any further clarification, please contact the Authority's planning department.

Please complete using block capitals and black ink.

( mportant that you read the accompanying guidance notes as incorrect completion will delay the processing of your application.

1. Applicant Name and Address

Title:

Last name:

Company

(optional):

Unit:

House

name:

Address 1:

Address 2:

-- 'dress 3:

Town:

County:

Country:

Postcode:

First name: 0411

House

number.

House

suffix:

0 ti AlOn t'ktt

606)(4-5kie_

6Uetic

tylito4YA

4111 1? 17t-

2. Agent Name and Address

Title:

Last name:

Company

(optional):

wot-60`ite

House

name:

Address 1:

Address 2:

Address 3:

Town:

County:

Country:

Postcode:

fitk First name: 5-1-eNen

zoc6eiti_ Pcok12-(k‘l 5

House

number:

House

suffix:

lf\LQ6Q_

KeUn v2(1/41

‘Otcxylof 6ickk

o1/4 ‘,St,e-t

v)e5N- Si1/4YSW

14(v)to-peA

Rkkl,o 15E

3. Description of Proposed Works

Please describe the proposed works.

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VA-6 .Py-fo,ey A.-ocyc uzAk ‘06 klka-Erdk is)\1/4\1\ Wc.. (46( P-NA

tAs\v‘dov).

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$Date 2010 09-10 9$ Sflevision 2999$

3. Description of Proposed Works (continued)

Has the work already started? Yes reNio

If Yes, please state when the work was started (DD/MM/YYYY):

Has the work already been completed? Yes N'No

If Yes, please state when the work was completed (DD/MM/YYYY):

(date must be pre-application submission)

(date must be pre-application submission)

4. Site Address Details

Please provide the full postal address of the application site.

House

number. Unit:

House

name:

Address 1:

Address 2:

Address 3:

Town:

County:

Postcode

(optional):

Description of location or a grid reference.

(must be completed if postcode is not known):

Northing:

House

suffix:

6Dvi,ynkosn

.-SovkArnode

c ce\_WQ-k

\Ae5V- y3 e-?‹

VA-M ee TA

Easting:

Description:

6. Pedestrian and Vehicle Access, Roads and Rights of Way

Is a new or altered vehicle access

proposed to or from the public highway? Yes No

Is a new or altered pedestrian access

proposed to or from the public highway? Yes VNo

Do the proposals require any diversions,

extinguishments and/or creation of public

rights of way? Yes No

If Yes to any questions, please show details on your plans or

drawings and state the reference number(s) of the plan(s)/

drawing(s)

5 . Pre-appl icat ion Advice

Has ass i sta nce or p rio r advice been soug ht from the loca l

a utho r i ty a bout th is a pp l i cat ion ? rWres

If Yes, p lea se com p lete the fo l lowi n g i nfo rmat i on a bo ut

you were g iven . (Th i s wi l l he lp the a uthor i ty to dea l with

a pp l icat ion more effic i ent ly) .

P lease t ick if the fu l l contact deta i l s a re not

known, and then comp lete as much a s poss i b l e.

Office r name:

the

th is

advice

No

VA-NAT) irkW \-11A.1244-

Refe rence: (

Date (DD/MM/YYYY) :

(m ust be p re-app l ication su bm i ss i on)

Deta i l s of p re-a pp l i cat i on advice rece ived?

AMC \,30'6 \-C3U- kAke_ I C/ ne

11\°1/46 Ci . C 0 ak V\k0 V \

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7. Trees and Hedges ---1

Are the re a ny trees o r hedges on you r own (

property o r on adjoi n i ng p roperti es wh i ch

a re with i n fa l l i ng d i sta nce of your p roposed

deve lopment? Yes No

If Yes, p lea se ma rk the i r pos i t i on on a sca led

p la n a nd state the refe rence n umber of a ny p la n (s)/d rawi ng (s) :

Wi l l a ny t rees o r hedges need to be removed

or p ru ned i n order to ca rry out your p roposa l ? I 1 Yes gi No

If Yes, p l ea se show on you r p l a n s wh ich t rees by g ivi ng them

n umbers e .g . Ti , T2 etc, state the refe rence n umber of the p la n (s)/

d raw i ng (s) a nd i nd icate the sca l e .

Spate 2010-09-10 #$ $Revision 2999$

(8. Materials

Please provide a description of existing and proposed materials and finishes to be used in the building (demolition excluded):

Ex i st i ng

(where a pp l ica b le) P roposed

Don 't

Kn ow

Exte rna l wa l l s& c { N-0

)0 e_ Seonot3ecN

Z,kke i lt\kk ki ‘.k

k-o c-a vke \\ Oka\ 6' (/'°°,1,16/)

I I

Roof cover i ng r/ I I

Ch imney VI

Windows

A)02 ruS\ Actel l.e)

WMA- 1 6`CK kk.L.e 0A-\01

n

Externa l doors

o\00{ k-o b e cevetcoa

X°°( N-0 be e vvvAA2cK

Aiev) &Our i y‘

c ‘o1M- -6) QW:sovi

Cei l i ngs

,N0 c_ seAk■Afj (5\1\ k--1“z

k..X‘NtAhn

i)te.,51-ef ce\‘‘knci 5045

I nterna l wa l l s )0 .C‘c_ e& wa\ocAr. ii\ )t.kk

100_ civtsk-eir-bockek k,- ck.vo

d‘kIr\ Soww. LekoVex I I I I

F l oo rs

I nterna l doors I I I I

i i nwate r goods I 1

Bounda ry t reatments

(e .g . fences, wa l l s)

k itvoyz &,‘,1/4) AO •C-'e c2 \i‘ e,_

`lk- 0 RsLyNc a•oof N I

Vehic l e access a nd

ha rd stand ing Lk - I Or\ X kk:t fv\

I I I I

L ighti ng [Nr LI

Othe rs

(add descript ion)

Nil' LI

Are you supplying additional information on submitted drawings or plans?

If Yes, please state plan(s)/drawing(s) references:

es No

$Date 2010-09-10#$ $Revision 2999$

e9. Demol ition

Does the proposa l i nc l u de the pa rt i a l o r

tota l demo l it ion of a l i sted bu i ld i ng? [

If Yes, wh ich of the fol lowing does the proposa l i nvolve ?

a ) Tota l demo l it i on of the l i s ted b u i ld i ng: I

b) Demo l it i on of a bu i ld i ng with i n

the cu rt i l age of the l i sted bu i l d i ng :

c) Demo l ition of a pa rt of the l i sted bu i ld i ng :

If the a nswer to c) i s Yes :

I Yes I o

Yes I I No

- s I No

Yes I I No

i ) What i s t he tota l vo l ume of the

l i sted bu i ld i ng?(cub ic metres)

i i ) What i s t he vo l ume of t he pa rt

to be demol i s hed ? (cubic metres)

i i i ) What was the (approx i mate) • ; te of the

erect ion of the pa rt to be remo - d? (MM/YYYY)

(date must be p re-a pp l i cation ubmiss ion)

P lease p rovide a br ief des , r i pt i on of the bu i ld i ng or pa rt of the bu i l d i ng you a re p ropos ! • to demo l i s h :

Why is i t nec - ssa ry to demol ish o r extend (a s a pp l i ca b le) a l l o r pa rt of the bu i l . ' ng (s) a nd or structu re(s) ?

S. ..,

el 1. Listed Building Grading

Please state the grading (if known) of the building in th

Buildings of Special Architectural or Historic interes

one box must be ticked)

Grade I El Ecclesi cal Grade I

Grade II* El

Grade ll

cclesiastical Grade II*

Ecclesiastical Grade It

Don't know

t of

ote: only

II

13. Parking

Will the proposed works affect

existing car parking arrangements?

If Yes, please describe:

n Yes [7.1\lo

'10. Listed Building Alterations

Do the proposed works include alterations

to a listed building?

If Yes, do the proposed works include:

(you must answer each of the questions)

a) Works to the interior of the building?

b) Works to the exterior of the building?

c) Works to any structure or object fixed

to the property (or buildings within

its curtilage) internally or externally? pi Yes V1 No

Yes

es

d) Stripping out of any internal w II, ceiling

or floor finishes (e.g. plaster, flo rboards)? I I Yes KR-10

If the answer to any of th e questions is Yes, please provide

plans, drawings, photos aphs sufficient to identify the location,

extent and character o the items to be removed, and the

proposal for their re acement, including any new means of

structural support d state references for the plan(s)/drawing(s):

12. Immunity From Listing

Has a Certificate of Immunity from Listing been sought in

this building?

ri Yes No

If Yes, please provide the result of th plication:

't know

pect of

14. Authority Employee / Member

With respect to the Authority, I am:

(a) a member of staff Do any of these

(b) an elected member statements apply to you?

(c) related to a member of staff

(d) related to an elected member Yes

If Yes, please provide details of the name, relationship and role

Spate 2010-09-10 9$ $Revision 2999$

(15. Ownership Certificates

One certificate A, B, C, or D must be completed, together with the Agricultural Holdings Certificate with this application form

CERTIFICATE OF OWNERSHIP - CERTIFICATE A

Town and Country Planning (Development Management Procedure) (England) Order 2010 Certificate under Article 12 &

Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990

I certify/The applicant certifies that on the day 21 days before the date of this application nobody except myself/ the applicant was thE

owner (owner is a person with a freehold in terest or leasehold in terest with at least 7 years left to run) of any part of the land or building tc

which the application relates.

Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):

CERTIFICATE OF OWNERSHIP - CERTIFICATE B

Town and Country Planning (Development Management Procedure) (England) Order 2010 Certificate under Article 12 &

Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990

I certify/ The applicant certifies that I have/the applicant has given the requisite notice to everyone else (as listed below) who, on the day

21 days before the date of this application, was the owner (owner is a person with a freehold in terest or leasehold in terest with at least 7 years

left to run) of any part of the land or building to which this application relates.

Name of Owner Address Date Notice Served

1— ) 0 U l k-On V:kkk 6 ooAtloR t 1 I 0A. 2.0G

Signed - Applicant: Or signed - Agent:

130ft Date (DD/MM/YYYY):

1-116-31z0vs

CERTIFICATE OF OWNERSHIP - CERTIFICATE C ,

Town and Country Planning (Development Management Procedure) (England) Order 2010 Certificate under Article 12 &

Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990

I certify/ The applicant certifies that:

• Neither Certificate A or B can be issued for this application

• All reasonable steps have been taken to find out the names and addresses of the other owners (owner is a person with a freehold

in terest or leasehold in terest with a t least 7 years left to run) of the land or building, or of a part of it, but I have/ the applicant has

been unable to do so. 2 steps taken were:

Name of Owner Address Date Notice Served

Notice of the application has been published in the following newspaper

(circulating in the area where the land is situated):

Signed - Applicant: Or signed - Agent:

On the following date (which must not be earlier

than 21 days before the date of the application):

Date (DD/MM/YYYY):

$Date 2010 09-10 #$ $RevIslon 2999$

.)

1 5 . Ownersh ip Cert ificates (cont inued)

CERTIF ICATE OF OWNERSHI P - CERTIF ICATE D

Town and Country Plann ing (Development Management Procedu re) (Eng land) Order 201 0 Certificate under Art i c le 1 2 &

Regu lat ion 6 of the Plann ing (Listed Bu i ld ings and Conservation Areas) Regu lations 1 990

I cert ify/ Th e appl i cant cert i fies that:

• Certificate A ca n n ot be iss ued for th is a pp l icat i o n

• Al l reasonab le steps have been taken to fi nd o ut the names a nd addresses of eve ryone e l se who, on the day 2 1 days before the

date of t h is a pp l icat ion, was the owner (owner is a person with a freehold interes t or leasehold interest with at least 7 years left to run)

of a ny pa rt of the la nd to wh ich th is app l i cat ion re l ates, but I have/ t he a pp l i cant has been u nab l e to do so.

The steps ta ken were :

Not ice of the app l icat ion has been pu bl ished i n the fol l owi ng newspape r On the fo l l owing date (wh ich must not be ea rl i e r

(c i rcu lati ng in the a rea where the la nd is s i tuated) : than 2 1 days before the date of the a pp l i cat ion) :

S ig ned - App l ica nt : Or s ig ned - Agent : Date (DD/MM/YYYY) :

"16. Agricultural Land Declaration

AGRICULTURAL LAND DECLARATION

Town and Country Planning (Development Management Procedure) (England) Order 2010 Certificate under Article 12

Agricultural Land Declaration - You Must Complete Either A or B

(A) None of the land to which the application relates is, or is part of, an agricultural holding.

Signed - Applicant: Or signed - Agent: Date (DD/MMNYYY):

lq (631 zo3

B) I have/ The applicant has given the requisite notice to every person other than myself/ the applicant who, on the day 21 days

before the date of this application, was a tenant of an agricultural holding on all or part of the land to which this application relates,

as listed below:

Name of Tenant Address Date Notice Served

Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):

,

17. Planning Application Requirements - Checklist

Please read the following checklist to make sure you have sent all the information in

information required will result in your application being deemed invalid. It will not

the Local Planning Authority has been submitted.

The original and 3 copies of a The original and 3 copies of a

completed and dated application form:

The original and 3 copies of a plan which

identifies the land to which the application

relates drawn to an identified scale

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:

Ei

Li

design and access statement if

proposed works fall within a

conservation area or

World Heritage Site, or relate to a

Listed Building:

support of your proposal. Failure to submit all

be considered valid until all information required by

The correct fee:

The original and 3 copies of the completed, dated Ownership Certificate

0 (A, B, C or D - as applicable):

The original and 3 copies of the

completed, dated Article 12 Certificate

(Agricultural Holdings):

o

iii

$Date 2010-09-10#$ $Revlsion 2999$

ll

e-- 18. Declaration

I/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional

information.

Signed - Applicant:

■

Or signed - Agent. Date (DD/MM/YYYY):

ict /C3 l 2-08 (date cannot be

pre-application)

19. Applicant Contact Details

Telephone numbers

Country code: National number:

Country code: Mobile number (optional):

Country code: Fax number (optional):

Email address (optional):

Extension

number:

'20. Agent Contact Details

Telephone numbers

Country code: National number:

-(-44 Country code: Mobile number (optional):

*--t-t *NEM Country code: Fax number (optional):

Email address (optional):

Extension

number:

I. Site Visit

Can the site be seen from a public road, public footpath, bridleway or other public land?

If the planning authority needs to make an appointment to carry

out a site visit, whom should they contact? (Please select only one) I I Agent

If Other has been selected, please provide.

Contact name:

11011.1111111mi Email address:

Yes

Kziplicant

Telephone number:

fl No

1 Other (if different from the

agent/applicant's details)

•1111111•111111111i

C OVVS0 \-C;•-\NC..1 e r\.‘ Q f\cOrke k 0 e.f.k--( - c_d. 0

$Date 2010-09-1O#$ $Revision 2999$