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Telephone number Agent's e-mail address
Please note correspondence is preferred and may be more expeditious via email c) If you are using an Agent, please specify whether the acknowledgement letter and Site Notice should be sent to the Agent or Applicant, who will be responsible for affixing the Site Notice at the site. Please Note: If this box is not completed all correspondence will be directed to the Agent.
Please ensure that the following information (question 6) corresponds with the details included on the accompanying and compulsory certificate of ownership (Certificate 01). 6. Name and Address of: a) the site owner, if different from the applicant. Please state all names, including first names in full. \square b) The name of occupier or tenant of the site if different from above. \square c) Does the applicant own or control any additional land within the vicinity of the application. If yes, you must outline the additional land in blue on the site plan. 7. Applicant's interest in the site (e.g. owner, tenant, potential purchaser)
Cheques should be made payable to ZON Government. If the proposed development would create additional industrial, residential, retail or office floor space, please specify the floor area in square metres This area should be used to where the fee calculus requires it. Where the application is exempt from a fee under the current fees order, please state the registered charity number. 9. a) Please state the existing use of the site (e.g. residential, office, retail etc.) b) Please state the proposed use of the site. 10. a) Development within a Conservation Area.
If yes, please include details of any deryultion involved on a separate sheet. b) Works proposed to a Registered Building.
If yes, please quote the R8 nunjber and complete an application for Registered Building Consent to accompany this form (form R8A/1). 11. Are the activities Retrospective or as a result of an Enforcement Enquiry? If as a result of an enforcement enquiry please quote reference and the date that the building work or use was started/completed. \square
If yes, please provide drawings showing the change in site levels (e.g. spot levels or site sections). Please also include a method statement detailing the proposed means of importing fill and/or the means of exporting the fill, including details of the expected quantities involved. 15. Please specify below whether the proposal requires new or amended services: a) Gas Yes \square b) Electricity Yes \square c) Water Yes \square d) Telecommunications Yes \square No \square
The applicant should consult the service providers separately in order to establish the location of existing services and the impact of the proposed works on existing services. See guidance notes. 16. a) How will rainwater run-off from roofs and paved surfaces be disposed of? b) How will foul sewage from the proposed development be disposed of? c) If a septic tank/Biodisc system is proposed, please provide details demonstrating that the septic tank/Biodisc would be acceptable under Building Regulations - See guidance notes. 17. a) Are there trees, large shrubs or hedges on the proposed development site? Yes \square No \square b) Are there any trees or hedges within 15 metres of the proposed development site? Yes \square No \square If you answered Yes to either of the above, then your application will need to include accurate tree survey drawings showing the position of the trees and hedges and their canopy spread in relation to the proposed works. You must provide details of any trees which are to be "topped' or 'filled' as a result of the proposal. For trees to be retained you will need to demonstrate that the constraints imposed by these trees have been properly considered and that the trees can be adequately protected. The above works must be discussed with the Department's Forestry, Amenity & Lands Directorate before the application is submitted. The Planning Officer may also require you to submit a Tree Survey. 18. Are the proposed works within 9 metres of any watercourse (river, ditch or otherwise)? If so, you are advised to contact the Department's Environment Safety and Health Directorate for further guidance in respect of this application. 19. Have you received pre-application advice from a Planning Officer? Yes \square No \square If yes, please state the Officer's name and the date of their response. \square
This certificate provides confirmation that the owner of the land which is the subject matter of the application is either the applicant or is fully aware of the application.
The certificate constitutes a statement of ownership and is not proof of ownership.
The applicant is requested to complete either Statement A or Statement B and return the completed certificate along with the planning application form and any supporting documents.
NO APPLICATION WILL BE PROCESSED UNTIL SUCH TIME AS THE CERTIFICATE IS SUBMITTED.
I certify that the accompanying application is made by or on behalf of the owner of the land, namely:
ALBERT EDWARD LAWRENCE BLANN
(Full names in CAPITAL letters)
who is:
(a) the full* /limited* owner of the freehold* /leasehold* estate in the land (*delete as appropriate); and
(b) in full possession of every part of the land to which the application relates.
If the application is made on behalf of the land owner, a certified copy of the power of authority signed by the owner authorising the application on his behalf is attached hereto.
I certify that appropriate written notice of the accompanying application has been given by or on behalf of the applicant to:
(a) the land owner (referred to in statement A of this certificate); and
(b) to any person who at the time of the making of the application was:
(i) a person then in actual possession
(ii) the trustee of a trust or settlement if a beneficiary under the trust or settlement was in actual possession and no person other than such a beneficiary was entitled to enter into actual possession within a period of 40 years; and
(iii) a person, not being a person falling within (a) or (b) (i) and (ii), entitled to enter into actual possession within a period of 40 years.
The persons upon whom notice was issued are:
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