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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.
Telephone number Applicant E-Mail Address Site Address. A plan must accompany this application to identify the land. The land should be outlined in red. 2. a) Full name of Agent b) Address of Agent
Telephone number Agent E-Mail Address 3. Name and address of owner of site if different from the applicant. 4. Please provide the name and address of any other person known to have an interest in the land and indicate whether any such other person has been notified of the application. 5. What is the Applicant's interest in the site? (e.g. owner, potential purchaser etc.)
If yes, please state the date the use started. And name the use class applicable now. b) To make lawful a proposed use of the buildings or land?
If yes, please state the current or last know use of the land. And the name of any use class applicable to the proposed use.

I/We the named applicant(s) hereby apply for a certificate of lawfulness, in respect of the matters set out above and in accordance with the information submitted herewith.
Signature of Applicant or Agent
I herewith enclose: Date 27.02.18
It is requested that three copies of this application form and all supporting statements and plans are forwarded to the address below.
The Department may by notice in writing require the applicant to provide such further information as may be specified to assist in its consideration of the application.
On validation of the application, the Department will issue a Notice to the Local Authority and any such person as noted in answer to section 4 of this form. The Notice will invite written representation as to the content of the application. If necessary the Department will advertise this application by way of the weekly planning publication list.
Under Section 24(4) of the Town and Country Planning Act 1999, any person who for the purpose of procuring a particular decision on an application for a certificate: a) knowingly or recklessly makes a statement which is false or misleading in a material particular; b) with intent to deceive, use a document which is false or misleading in a material particular; c) with intent to deceive, withholds any material information;
is guilty of an offence and may be liable: a) on summary conviction to custody for a term not exceeding 6 months or to a fine not exceeding £10000, or both; b) on convictions on information to custody for a term not exceeding 2 years, or to a fine, or both.
Please note that the Department retains powers under Section 24(5) of the 1999 Act, Section 5 of the Regulations, to revoke a certificate.
Planning and Building Control Directorate Department of Environment, Food and Agriculture Murray House, Mount Havelock, Douglas, Isle of Man, IM1 2SF Tel: +44 1624 685950 Fax: +44 1624 686443 Email: [email protected]
Form LAW1.4(j)
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