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INFORMATION FORM

This form is intended to give us the basic information needed to tailor a letter(s) to suit your local campaigns needs. All information passed to Planning Sanity is confidential, and only viewed on a need to know basis. If we need further information then we will come back to you. If you need help with compiling representations to planning inquiries then please contact us separately, as work of that nature requires considerable more input. We are an unfunded organisation andtherefore to help us provide the level of support that we do, we ask that you make a minimum donation of ten pounds (UK) per letter that we compile on your behalf. Although those communties that cannot genuinely afford to contribute towards Planning Sanity's existence will not be penalised for not contributing.

Planning Authority from Planning Sanity	Planning Authority from local residents	Planning Authority Standard Letter Wide Distribution	Land Owner	Operator Code Para 17	Network Rail	Church

I/we authorise Planning Sanity to make representations on my/our behalf (please put an X)

Campaign Details

Local Contact Details

TITLE

FIRST NAME

LAST NAME

HOME TEL
WORK TEL
FAX

CONTACT ADDRESS

POST CODE

EMAIL ADDRESS

NAME OF CAMPAIGN OR COMMUNITY GROUP

CAMPAIGN WEB SITE
Note: Planning Sanity can help with free basic WEB space for campaigns for those without WEB space

Please give a short discription of your campaign/organisation

Code System Operator Info

Name of Code System Operator

Name of Applicant/Operators Agent (if known)

CONTACT ADDRESS

POST CODE

Details of Landowner

Name of Land Owner (if known)

Address of Land Owner (if known)

POST CODE

Details of Proposed Telcom Site

Address of proposed telecom development

POST CODE

Details of Planning/Prior Approval Application

Local Authority Planning Application Number

Address of Local Planning Authority

POST CODE

What date was the application for planning permission
or prior approval submitted to the local planning authority?
Has planning permission/prior approval been granted?
If so what was the date of the grant of permission?

If it was a prior approval application has the local planning authority
notified the operator within the statutory 56 day period?
Has the development taken place?
If so what was the date of completion of the physical development?

Please check as many of the following that apply

Ground Based Mast Under 15 metres in height	Ground Based Mast Over 15 metres in height	Mast/Antenna on a Building (or other structure) Where the building/structure is under 15 metres in height	Mast/Antenna on a Building (or other structure) where the building/structure is over 15 metres in height

Is the accumulation of existing and proposed equipment cabins above 2.5 cubic metres?	Is the accumulation of existing and proposed ground based equipment cabins above 150 cubic metres?	Is the accumulation of existing and proposed equipment cabins installed on a building or structure above 30 cubic metres?	If the installation is on a building will the installation when completed be on a wall or roof slope facing a highway that is within 20 metres of the building or structure?

Please answer as many of the following questions as possible

Please indicate the height of proposed mast/installation?

Please give an indication of whether there are any other features of the development that raises concerns? (generators, access ladders onto roofs........... )

Has there been any other similar applications on the proposed site that has been refused permission in the last two years?

Is the proposed installation on a listed building. Or sited so that it will have an adverse effect on a listed building?

Is the site of the proposed installation within a conservation area or national park?

Please give the approximate distance of the proposed installation from all local school/nursery boundaries?

Please give an indication of the distance from the nearest dwelling?

Please give an indication of the distance from the nearest place of employment and set out the type of employment?

Are there any children's play areas close to the proposed site?

Is the site an urban or rural location?

Is the installation sited in a location that will affect wildlife or farm lifestock? (is so please give an indication of the species and how you feel it would affect that species)

Please give a short discription of the site, i.e. is it in a field, industrial estate, is it already developed, what is the building it is to beplaced on used for etc.

How many other existing installations are you aware of within 500 metres of the proposed site? (please give approximate distances)

How do you think the proposed installation will affect the visual amenity of the area?

Are you aware of any access or land ownership problems if so please set out the envisaged problem?

Do you or any of your neighbours have any ailments or disabilities that you consider might be affected from emissions to a greater degree than the average person, if so please list them, and any medical treatment you are under going?

On average property prices can fall by up to 25%. Have you inquired of your local estate agent and been given any figures, if so what is the percentage drop in value?

How do you see that your property (home) will be affected by the following statement:- "the enjoyment of which, or interest in which, is, because of the nearnest of the land to the land on or over which the apparatus has been installed, capable of being prejudiced by the apparatus"?

Please set out any other information you consider might be useful to us in compiling your letter(s).

Next click on the DONATION button to make your donation by Credit Card. After making payment you will be returned to this form, check the details on the form is correct then click on the 'SUBMIT' button to send the form to Planning Sanity. If making your donation by other means do not use the donation button, instead either click on 'SUBMIT' button to send the form. Or print the form out to send by post.

IF SUBMITTING YOUR FORM BY POST PLEASE PRINT AND SEND WITH SUBSCRIPTION/DONATION TO
Planning Sanity, 56 Kimmeridge Ave, Parkstone, Poole, Dorset, BH12 3NX made payable to CfPS Top of Page

THIS CAMPAIGN IS FUNDED FROM YOUR DONATIONS - PLEASE GIVE GENEROUSLY
FUNDRAISING SECTION

What date was the application for planning permission or prior approval submitted to the local planning authority?	Has planning permission/prior approval been granted?	If so what was the date of the grant of permission?
If it was a prior approval application has the local planning authority notified the operator within the statutory 56 day period?	Has the development taken place?	If so what was the date of completion of the physical development?