BEFORE FILLING OUT THIS FORM PLEASE NOTE THE
FOLLOWING
Failure to complete this form or attach the necessary documentation, or the submission of incorrect information or omission of required information will lead to the invalidation of your application. Therefore please ensure that each section of this application form is fully completed and signed, entering n/a (not applicable) where appropriate, and that all necessary documentation is attached to the application form.
                                       ADDITIONAL INFORMATION
It should be noted that each planning authority has its own development plan, which sets out local development policies and objectives for its own area. The authority may therefore need supplementary information (i.e. other than that required in this form) in order to determine whether the application conforms with the development plan and may request this on a supplementary application form.
Failure to supply the supplementary information will not invalidate your planning application but may delay the decision-making process or lead to a refusal of permission. Therefore applicants should contact the relevant planning authority to determine what local policies and objectives would apply to the development proposed and whether additional information is required.
OTHER STATUTORY CODES
An applicant will not be entitled solely by reason of a planning permission to carry out the development. The applicant may need other consents, depending on the type of development. For example, all new buildings, extensions and alterations to, and certain changes of use of existing buildings must comply with building regulations, which set out basic design and construction requirements. Also any works causing the deterioration or destruction of the breeding and resting places of bats, otters, natterjack toads, Kerry slugs and certain marine animals constitute a criminal offence unless covered by a derogation licence issued by the Minister for Arts, Heritage and the Gaeltacht (pursuant to Article 16 of the Habitats Directive).
DATA PROTECTION
The use of the personal details of planning applicants, including for marketing purposes, may be unlawful under the Data Protection Acts 1988-2003 and may result in action by the Data Protection Commissioner against the sender, including prosecution.

PLANNING APPLICATION FORM
1.NAME OF RELEVANT PLANNING AUTHORITY:	
	
  2. LOCATION OF DEVELOPMENT:	
 Postal Address or Townland
 or Location (as may best
 identify the land or structure
 in question	

	
 Ordnance Survey Map Ref.
 No. (and the Grid Reference
 where available)

		

  3.TYPE OF PLANNING PERMISSION (PLEASE TICK APPROPRIATE BOX):
	
 [  ] Permission
 [  ] Permission for retention
 [  ] Outline Permission
 [  ] Permission consequent on Grant of Outline Permission	

4.WHERE PLANNING PERMISSION IS CONSEQUENT ON GRANT OF OUTLINE PERMISSION:	

Outline Permission Register Reference Number:……………………………………

Date of grant of Outline Permission: …....../…….…/.….…..

  5.APPLICANT:	
  Name(s)		
 Contact details	 to be supplied at the end of this form.
(Question: 24)

	

  6. WHERE APPLICANT IS A COMPANY (REGISTERED UNDER THE   
    COMPANIES ACTS):
	
  Name(s) of company
 director(s)

	
 Registered Address
 (of company)	

	
 Company Registration
 Number	

	

 7. PERSON/AGENT ACTING ON BEHALF OF THE APPLICANT (IF ANY):	
  Name		
 Address	 to be supplied at the end of this form (Question 25)

 8. PERSON RESPONSIBLE FOR PREPARATION OF DRAWINGS AND PLANS:
	
 Name	
	
 Firm/Company	

 9. DESCRIPTION OF PROPOSED DEVELOPMENT::
	
 Brief description of    
 nature and extent of  
 development	

	

 10. LEGAL INTEREST OF APPLICANT IN THE LAND OR STRUCTURE:	
 Please tick appropriate box.
 Where legal interest is ‘Other’, please
 expand further on your interest in the       
 land or structure	A. Owner	B. Occupier	
	C. Other

	
 If you are not the legal owner, please   
 state the name and address of the  
 owner and supply a letter from the 
 owner of consent to make the 
 application as listed in the
 accompanying documentation		

 11. SITE AREA:

 Area of site to which the application relates in hectares    ………………………….ha

 ………………..ha

	
 12. WHERE THE APPLICATION RELATES TO A BUILDING OR BUILDINGS:	
 
 Gross floor space5 of any existing building(s) in m2		

 Gross floor space of proposed works in m2

 Gross floor space of work to be retained in m2 (if
 appropriate)		

 Gross floor space of any demolition in m2 (if             appropriate)		
 13.IN THE CASE OF MIXED DEVELOPMENT (E.G. RESIDENTIAL, COMMERCIAL, INDUSTRIAL, ETC), PLEASE PROVIDE BREAKDOWN OF THE DIFFERENT CLASSES OF DEVELOPMENT AND BREAKDOWN OF THE GROSS FLOOR AREA OF EACH CLASS OF DEVELOPMENT:

      
         Class of Development	    	
         Gross floor area in m2	

		

		

 14. IN THE CASE OF RESIDENTIAL DEVELOPMENT PLEASE PROVIDE
 BREAKDOWN OF RESIDENTIAL MIX:	
Number of	Studio	1 Bed	2 Bed	3 Bed	4 Bed	4+ Bed	Total	
Houses								

Apartments							

	
Number of car-
parking spaces to be provided	

	   Total	

15. WHERE THE APPLICATION REFERS TO A MATERIAL CHANGE OF USE   
 OF ANY LAND OR STRUCTURE OR THE RETENTION OF SUCH A 
 MATERIAL CHANGE OF USE:	
 Existing use6 (or previous   
 use where retention 
 permission is sought)		

 Proposed use (or use it is
 proposed to retain)		
 Nature and extent of any  
 such proposed use (or use  
 it is proposed to retain)		
16. SOCIAL AND AFFORDABLE HOUSING:	
(Please tick appropriate box)	Yes	No	
Is the application an application for permission for
development to which Part V of the Planning and
Development Act 2000 – 2021 applies?7			
If the answer to the above question is “yes” and the
development is not exempt (see below), you must
provide, as part of your application, details as to how you propose to comply with section 96 of Part V of the Act, including for example, (i) details of such parts or parts of the land which is subject  to the application for permission or is or are specified by the Part V agreement, or houses situated on such aforementioned land or elsewhere in the planning authority’s functional area proposed to be transferred to the planning authority, or details of houses situated on such  aforementioned land or elsewhere in the planning authority’s functional area proposed to be leased to the planning authority, or details of any combination of the foregoing, and
(ii) details of the calculations and methodology for calculating values of land, site costs, normal construction and development costs and profit on those costs and other related costs such as an appropriate share of any common development works as required to comply with the provisions in Part V of the Act. 

			
If the answer to the above question is “yes” but you
consider the development to be exempt by virtue of
section 97 of the Planning and Development Act
2000- 20218, a copy of the Certificate of Exemption under
section 97 must be submitted (or, where an
application for a certificate of exemption has been
made but has not yet been decided, a copy of the
application should be submitted).

If the answer to the above question is “no” by virtue
of section 96(13) of the Planning and Development
Act 20009, details indicating the basis on which
section 96(13) is considered to apply to the
development should be submitted.			
17. DEVELOPMENT DETAILS:	
Please tick appropriate box	Yes	No	
 Does the proposed development consist of work to a protected  
 structure and/or its curtilage or proposed protected structure 
 and/or its curtilage?			
 Does the proposed development consist of work to
 the exterior of a structure which is located within an
 architectural conservation area (ACA)?			
 Does the application relate to development which
 affects or is close to a monument or place recorded
 under section 12 of the National Monuments
 (Amendment) Act, 199410?			
 Does the proposed development require the
 preparation of an Environmental Impact
 Statement11?			
 Does the application relate to work within or close
 to a European Site (under S.I. No. 94 of 1997) or a
 Natural Heritage Area12?			
 Does the application relate to a development which
 Comprises or is for the purposes of an activity
 requiring an integrated pollution prevention and  control   
 licence?
			
 Does the application relate to a development which
 comprises or is for the purposes of an activity
 requiring a waste licence?			
 Do the Major Accident Regulations apply to the
 proposed development?			
  Does the application relate to a development in a
 Strategic Development Zone?			
 Does the proposed development involve the
 demolition of any structure?			

18. SITE HISTORY	
 Details regarding site history (if known)	

Has the site in question ever, to your knowledge, been flooded?
Yes[ ]	No[ ]
If yes, please give details e.g. year, extent:
 ________________________________________________________

 ________________________________________________________

 ________________________________________________________
Are you aware of previous uses of the site e.g. dumping or quarrying?
Yes[ ]	No[ ]
If yes, please give details.

 ________________________________________________________

 ________________________________________________________	
 Are you aware of any valid planning applications previously made in respect of this
 land/structure?	
Yes[ ]	No[ ]
If yes, please state planning reference number(s) and the date(s) of receipt of the planning application(s) by the planning authority if known:

Reference No.: 	Date: 	
If a valid planning application has been made in respect of this land or structure in the 6 months prior to the submission of this application, then the site notice must be on a yellow background in accordance with article 19(4) of the Planning and Development Regulations 2001 as amended.	
 Is the site of the proposal subject to a current appeal to An Bord Pleanála in respect   
 of a similar development 13?	
Yes[ ]	No[ ]
An Bord Pleanála Reference No:………………………………	

19.	PRE-APPLICATION CONSULTATION: 
Has a pre-application consultation taken place in relation to the proposed development14?	
Yes[ ]	No[ ]
If yes, please give details:
Reference No. (if any):	
Date(s) of consultation: 	/	/	
Persons involved: 		

20. SERVICES:		
Proposed Source of Water Supply		
Existing connection [  ]	  New connection [  ]
Public Mains [  ]	Group Water Scheme [  ]    Private Well [  ] 
   
Other (please specify):…………………………………………..
	
Name of Group Water Scheme (where applicable)………………………………………	

Proposed Wastewater Management/Treatment	

 Existing [  ]	 New  [  ]
		
 Public Sewer [  ]	Conventional septic tank system [  ]	
 Other on-site treatment system [ ]Please specify……………………………………..	
 Proposed Surface Water Disposal	
 
 Public Sewer/Drain [  ]  Soakpit [  ]

 Watercourse [  ]  Other [  ]  Please specify …………………………………………..

	

21. DETAILS OF PUBLIC NOTICE:	
Approved newspaper15 in
which notice was published		
Date of publication		
Date on which site notice was erected		

22.APPLICATION FEE:
	
Fee Payable

Basis of Calculation

23. DECLARATION:	
I hereby declare that, to the best of my knowledge and belief, the information given in this form is correct and accurate and fully compliant with the Planning and Development Act 2000, as amended, and the Regulations made thereunder.	
Signed
(Applicant or Agent as
 appropri ate)		
Date

		

         CONTACT DETAILS — NOT TO BE PUBLISHED
24.	APPLICANT ADDRESS/CONTACT DETAILS
	
 Address
	
 Email address
	
Telephone number (optional)	

25. AGENT’S (IF ANY) ADDRESS/CONTACT DETAILS:	
Address	
Email address	
Telephone number (optional)	
Should all correspondence be sent to the agent’s address (where applicable)?
Please tick appropriate box. (Please note that if the answer is ‘No’, all correspondence will be sent to the applicant’s address)

Yes[ ]	No []

A contact address must be given, whether that of the applicant or that of the agent.

A contact address must be given, whether that of the applicant or that of the agent 
   
This form should be accompanied by the following documentation:
Please note that if the appropriate documentation is not included, your application will be deemed invalid.
ALL Planning Applications
�	The relevant page of newspaper that contains notice of your application
�	A copy of the site notice
�	6 copies of site location map16
�	6 copies of site or layout plan16+17
�	6 copies of plans and other particulars required to describe the works to which the development relates (include detailed drawings of floor plans, elevations and sections — except in the case of outline permission)
�	The appropriate Planning Fee
Where the applicant is not the legal owner of the land or structure in question:
�	The written consent of the owner to make the application
Where the application is for residential development that is subject to Part V of the 2000 - 2021 Act:

Details of the manner in which it is proposed to comply with section 96 of Part V of the Act, including for example, 
(i) details of such parts or parts of the land which is subject  to the application for permission or is or are specified by the Part V agreement, or houses situated on such aforementioned land or elsewhere in the planning authority’s functional area proposed to be transferred to the planning authority, or details of houses situated on such  aforementioned land or elsewhere in the planning authority’s functional area proposed to be leased to the planning authority, or details of any combination of the foregoing, and
(ii) details of the calculations and methodology for calculating values of land, site costs, normal construction and development costs and profit on those costs and other related costs such as an appropriate share of any common development works as required to comply with the provisions in Part V of the Act. 
or
�	A certificate of exemption from the requirements of Part V
or
�	A copy of the application submitted for a certificate of exemption.
Where the application is for residential development that is not subject to Part V of the 2000 - 2021 Act by virtue of section 96(13) of the Act:
�	Information setting out the basis on which section 96(13) is considered to apply to the development.
Where the disposal of wastewater for the proposed development is other than   to a public sewer:
�	Information on the on-site treatment system proposed and evidence as to the suitability of the site for the system proposed.
Where the application refers to a protected structure/ proposed protected               structure/ or the exterior of a structure which is located within an architectural conservation area (ACA):
�	Photographs, plans and other particulars necessary to show how the development would affect the character of the structure.
Applications that refer to a material change of use or retention of such a        material change of use:
�	Plans (including a site or layout plan and drawings of floor plans, elevations and sections which comply with the requirements of article 23) and other particulars required describing the works proposed.
 Where an application requires an Environmental Impact Statement:
�	An Environmental Impact Statement
 Applications that are exempt from planning fees:
�	Proof of eligibility for exemption18

Directions for completing this form
1.	Grid reference in terms of the Irish Transverse Mercator.
2.	“The applicant” means the person seeking the planning permission, not an agent acting on his or her behalf.
3.	Where the plans have been drawn up by a firm/company the name of the person primarily responsible for the preparation of the drawings and plans, on behalf of that firm/company, should be given.
4.	A brief description of the nature and extent of the development, including reference to the number and height of buildings, protected structures, etc.
5.	Gross floor space means the area ascertained by the internal measurement of the floor space on each floor of a building, that is, floor areas must be measured from inside the external wall.
6.	Where the existing use is ‘vacant’ please state most recent authorised use of the land or structure.
7.	Part V of the Planning and Development Act 2000 - 2021 applies where—
•	the land is zoned for residential use or for a mixture of residential and other uses,
•	there is an objective in the Development Plan for the area for a percentage of the land to be made available for social and/or affordable housing, and
•	the proposed development is not exempt from Part V
8.	Under section 97 of the Planning and Development Act 2000- 2021, applications involving development of 9 or fewer houses or development on land of less than 0.1 hectare may be exempt from Part V.
9.	Under section 96(13) of the Planning and Development Act 2000 - 2021, Part V does not apply to certain housing developments by approved voluntary housing bodies, certain conversions, the carrying out of works to an existing house or the development of houses under an agreement made under section 96 of the Act.
10.	The Record of Monuments and Places, under section 12 of the National Monuments Amendment Act 1994, is available, for each county, in the local authorities and public libraries in that county. Please note also that if the pro-posed development affects or is close to a national monument which, under the National Monuments Acts 1930 to 2004, is in the ownership or guardianship of the Minister for Arts, Heritage and the Gaeltacht or a local authority, or is the subject of a preservation order or a temporary preservation order, a separate statutory consent is required, under the National Monuments Acts, from the Minister for Arts, Heritage and the Gaeltacht. For information on whether national monuments are in the ownership or guardianship of the Minister for Arts, Heritage and the Gaeltacht or a local authority or are the subject of preservation orders, contact the National Monuments Section, Department of Arts, Heritage and the Gaeltacht.
11.	An Environmental Impact Statement (EIS) is required to accompany a planning application for development of a class set out in Schedule 5 of the Planning and Development Regulations 2001-2021which exceeds a limit, quantity or threshold set for that class of development. An EIS will also be required by the planning authority in respect of sub-threshold development where the authority considers that the development would be likely to have significant effects on the environment (article 103).
12.	An appropriate assessment of proposed development is required in cases where it cannot be excluded that the proposed development would have a significant effect on a European site. It is the responsibility of the planning authority to screen proposed developments to determine whether an appropriate assessment is required and where the authority determines that an appropriate assessment is required, the authority will normally require the applicant to submit a Natura impact statement (NIS). Where the applicant considers that the proposed development is likely to have a significant effect on a European site it is open to him/her to submit a NIS with the planning application.
13.	The appeal must be determined or withdrawn before another similar application can be made.
14.	A formal pre-application consultation may only occur under Section 247 of the Planning and Development Act 2000- 2021. An applicant should contact his or her planning authority if he/she wishes to avail of a pre-application consultation. In the case of residential development to which Part V of the 2000 - 2021 Act applies, applicants are advised to avail of the pre-application consultation facility in order to ensure that a Part V agreement in principle can be reached in advance of the planning application being submitted.
15.	The list of approved newspapers, for the purpose of giving notice of intention to make a planning application, is available from the planning authority to which the application will be submitted.
16.	All plans, drawings and maps submitted to the planning authority should be in accordance with the requirements of the Planning and Development Regulations 2001-2021.
17.	The location of the site notice(s) should be shown on site location map.
18.	See Schedule 9 of Planning and Development Regulations 2001- 2021. If a reduced fee is tendered, details of previous relevant payments and planning permissions should be given. If exemption from payment of fees is being claimed under article 157 of the 2001 – 2021 Regulations, evidence to prove eligibility for exemption should be submitted.