(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
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.
%c,,reqe. owdfie f--
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VA-6 .Py-fo,ey A.-ocyc uzAk ‘06 klka-Erdk is)\1/4\1\ Wc.. (46( P-NA
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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
$Date 2010-09-1O#$ $Revision 2999$