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Please complete in BLOCK CAPITALS and in black ink.
The person here below named as the applicant is responsible for payment of the appropriate fee.
All relevant questions on this form must be answered.
| For office use only | | | --- | --- | | Date: 10/8/23 | | | Receipt number: 860992 | | | F12522222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222222
The Department of Environment, Food & Agriculture is a data controller for the purposes of the General Data Protection legislation and requires the information on this form to comply with its legal obligations under the Town and Country Planning Act 1999 and subordinate legislation.
Your personal information will be held by the DEFA for the purposes of processing this application and may be used to ensure compliance with the provisions of the Town & Country Planning Act and in particular Part 4 Enforcement of Control.
Some of the information you provide, such as your name, address and contact detail will be shared at our public counter, with the Local Authority and as part of the application image via our online service. It may also be shared within the DEFA or other Government Departments, boards or offices for the purposes of statutory functions. We will only keep these details for as long as we require them, and in accordance with the General Data Protection legislation.
You may withdraw your details at any time if you no longer wish us to process your application. Full details of how and why the DEFA processes your personal information are contained in our P&BC Privacy Notice.
The Department's Data Protection Officer can be contacted on 686781 or by email at [email protected].
I/We the named applicant(s) hereby apply for amendment to an approval, in respect of the matters set out and in accordance with the information submitted herewith.
The amendment detailed in this application is the ONLY change proposed from the approval as issued.
| Signature of Applicant or Agent | Date | 21-08-2023 | | --- | --- | --- | | | | | | | | | | | | | | | | | | Capacity (if signing on behalf of a company, please clearly state your relationship) | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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