# Householder Application For Planning Permission For Works Or Extension To A Dwelling. Town And Country Planning Act 1990

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.

## 1. Applicant Name, Address And Contact Details

Title:
Mr First Name:
Mark Surname:
Staniland Company name:
 
Street address:
16, Gorse Ridge Drive Telephone number:
 
 
Mobile number:
 
Town/City:
BASLOW 
Fax number:
 
Country:
 
Email address:
Postcode:
DE45 1SL 
 
Are you an agent acting on behalf of the applicant?

Yes No

## 2. Agent Name, Address And Contact Details

Title:
Mr First Name:
Benjamin Surname:
Smith Company name:
 
Street address:
30 Southview Crescent Telephone number:
07791213178 
 
Mobile number:
 
Town/City:
SHEFFIELD 
Fax number:
 
Country:
 
Email address:
Postcode:
S7 1DH 
bensmith_000@hotmail.com 

## 3. Description Of Proposed Works Please Describe The Proposed Works:

Replacement windows and doors/Internal alterations/extension to front elevation forming new porch  
Has the work already been started without planning permission?

Yes No

## 4. Site Address Details 5. Pedestrian And Vehicle Access, Roads And Rights Of Way

| Yes                          |
|------------------------------|
| Is a new or altered          |
| vehicle access               |
| proposed to or from          |
| the public highway?          |
| Is a new or altered          |
| pedestrian access            |
| proposed to or from the      |
| public highway?              |
| Do the proposals             |
| require any diversions,      |
| extinguishment and/or        |
| creation of public rights of |
| way?                         |

## 6. Pre-Application Advice

| Has assistance or prior advice been sought from the local authority about this application?   | Yes   | No   |
|-----------------------------------------------------------------------------------------------|-------|------|

## 7. Trees And Hedges

Are there any trees or hedges on your own property or on adjoining properties which are within
falling distance of your proposed development?
Yes
No
Will any trees or hedges need to be removed or pruned in order to carry out your proposal?
Yes
No

## 8. Parking

| Will the proposed works affect existing car parking arrangements?   | Yes   | No   |
|---------------------------------------------------------------------|-------|------|

## 9. Authority Employee/Member

Do any of these statements apply to you?
Yes
No
With respect to the Authority, I am: (a) a member of staff (b) an elected member (c) related to a member of staff (d) related to an elected member

## 10. Site Visit

| Can the site be seen from a public road, public footpath, bridleway or other public land?   | Yes   | No   |
|---------------------------------------------------------------------------------------------|-------|------|

## 10. Site Visit

If the planning authority needs to make an appointment to carry out a site visit, whom should they contact? (Please select only one)

## 11. Materials

Please state what materials (including type, colour and name) are to be used externally (if applicable):

Doors - description:
Description of *existing* materials and finishes:
Upvc 
Description of *proposed* materials and finishes:
Colour to match 
Roof - description:
Description of *existing* materials and finishes:
tiles 
Description of *proposed* materials and finishes:
tiles to match existing 
Walls - description:
Description of *existing* materials and finishes:
Stone 
Description of *proposed* materials and finishes:
Stone to match existing 
Windows - description:
Description of *existing* materials and finishes:
Upvc 
Description of *proposed* materials and finishes:
Colour to match 

Are you supplying additional information on submitted plan(s)/drawing(s)/design and access statement? If Yes, please state references for the plan(s)/drawing(s)/design and access statement:

associated drawings  

## 12. Certificates (Certificate A) Certificate Of Ownership - Certificate A Town And Country Planning (Development Management Procedure) (England) Order 2015 Certificate Under Article 14

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 interest or leasehold interest with at least 7 years left to run) of any part of the land to which the application relates, and that none of the land to which the application relates is, or is part of, an agricultural holding *("agricultural holding" has the meaning given by reference to the definition of "agricultural tenant" in section 65(8) of the Act)*.

## 13. Declaration

I/we hereby apply for planning permission/consent as described in this form and the accompanying plans/ drawings and additional information. I/we confirm that, to the best of my/our knowledge, any facts stated are true and accurate and any opinions given are the genuine opinions of the person(s) giving them.