“A unique and caring valley of service excellence, opportunity and growth.”
Address: Civic Centre, High Street, Private Bag X3046, WORCESTER, 6849
* Please address all correspondence to the Municipal Manager *
Web: www.bvm.gov.za
LAND USE PLANNING APPLICATION FORM
(Section 13 of the Breede Valley Municipal Land Use Planning By – Law)
NOTE: Please complete this form using BLOCK capitals and ticking the appropriate boxes.
PART A: APPLICANT DETAILS
First name(s)
Surname
SACPLAN Reg No.
(if applicable)
Company name
(if applicable)
Postal Address
Postal
Code
Email
Tel
Fax
Cell
PART B: REGISTERED OWNER(S) DETAILS (if different from applicant)
Registered owner
Address
Postal
code
E-mail
Tel
Fax
Cell
PART C: PROPERTY DETAILS (in accordance with Title Deed)
Property
Description
[Erf / Erven /
Portion(s) and
Farm number(s),
allotment area.]
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Page 1 of 6
Physical Address
GPS Coordinates
(If applicable)
Town/City
Current Zoning
Extent
m2 / ha
Are there existing
buildings?
Y
N
Y
N
Y
N
Zoning Scheme
Current Land Use
Title Deed
T
number & date
Any restrictive
If Yes, list
conditions
Y
N condition
prohibiting
number(s).
application?
Are the restrictive
conditions in
If Yes, list the
Y
N
favour of a third
party(ies).
party(ies)?
Is the property
If Yes, list
encumbered by
Y
N
Bondholder(s)?
a bond?
Has the
Municipality
If yes, list
already decided Y
N reference
on the
number(s)?
application(s)?
Are there any existing unauthorized buildings and/or
land use on the subject property(ies)?
Are there any pending court case / order relating to
the subject property(ies)?
Y
N
Y
N
If yes, is this application to legalize
the building / land use?
Are there any land claim(s)
registered on the subject
property(ies)?
PART D: PRE-APPLICATION CONSULTATION (If applicable)
Has there been any pre-application
consultation?
Y
Official’s name
Reference
number
N
If Yes, please complete the information below and if
available attach the minutes.
Date
consultation
of
PART E: LAND USE APPLICATIONS IN TERMS OF SECTION 13 OF THE BREEDE VALLEY MUNICIPAL LAND USE
PLANNING BY – LAW AND APPLICATION FEES PAYABLE
Tick
Section
Type of application
Cost
√
2(a)
a rezoning of land;
R
√
2(b)
R
√
2(c)
√
2(d)
√
2(e)
a permanent departure from the provisions of the zoning scheme;
a departure to use land on a temporary basis for which no provision is
made in the zoning scheme;
a subdivision of land including the registration of a new servitude or
lease agreement that is not exempted in terms of section 23,;
a consolidation of land;
R
R
R
Page 2 of 6
√
2(f)
√
2(g)
√
2(h)
√
√
2(i)
2(j)
√
2(k)
√
√
√
√
√
2(l)
2(m)
2(n)
2(o)
2(p)
an amendment, suspension or removal of restrictive conditions in
respect of a land unit;
a permission required in terms of the zoning scheme;
an amendment, deletion or imposition of conditions in respect of an
existing approval;
an extension of the validity period of an approval;
an approval of an overlay zone as provided for in the zoning scheme;
a phasing, amendment or cancellation of a plan of subdivision or a part
thereof;
a permission required in terms of the conditions of approval;
a determination of a zoning;
a closure of a public place or part thereof;
a consent use provided for in the zoning scheme;
an occasional use of land;
TOTAL A:
R
R
R
R
R
R
R
R
R
R
R
R
* Application fees that are paid to the Municipality are non-refundable and proof of payment of the application fees
must accompany the application.
** The applicant is liable for all costs pertaining to the advertising of the application.
BANKING DETAILS
An electronic fund transfer can be made to:
Bank:
Account name:
Branch code:
Account number:
Ref:
ABSA Worcester
Breede Valley Municipality
503 107
01 00 00 10 312
1200016165
(Please attach proof of payment with the submission of the application).
PART F: DETAILS OF PROPOSAL
Brief description of proposed development / intent of application:
PART G: ATTACHMENTS & SUPPORTING INFORMATION FOR LAND USE PLANNING APPLICATIONS
Please complete the following checklist and attach all the information relevant to the proposal.
Failure to submit all information required will result in the application being deemed incomplete. An
application will only be processed once it is complete.
Is the following compulsory information attached?
Power of Attorney / Owner’s consent if
Y
N
Y
N
Bondholder’s consent (if applicable)
applicant is not owner
Y
N
Motivation report / letter
Y
N
Proof of payment of fees
S.G. noting sheet extract / Erf
Y
N
Full copy of the Title Deed
Y
N
diagram / General Plan
Page 3 of 6
Supporting information and documentation:
N
/
A
N
/
A
N
/
A
N
/
A
N
/
A
Conveyancer’s Certificate
Y
N
N/A
Locality plan
Y
N
Proposed Subdivision Plan
(including street names and
numbers)
Y
N
N/A
Phasing Plan
Y
N
Consolidation Plan
Y
N
N/A
Land Use Plan / Zoning plan
Y
N
Site Development Plan
Y
N
N/A
Landscaping / Tree Plan
Y
N
Abutting owner’s consent
Y
N
N/A
Home Owners’ Association consent
Y
N
Y
N
N/A
1 : 50 / 1:100 Flood line
determination (plan / report)
Y
N
N
/
A
Y
N
N/A
Required number of documentation
copies (8 copies)
Y
N
N
/
A
N
N
/
A
Copy of Environmental Impact
Assessment (EIA) /
Heritage Impact Assessment
(HIA) /
Traffic Impact Assessment (TIA) /
Traffic Impact Statement (TIS) /
Major Hazard Impact
Assessment (MHIA) /
Environmental Authorisation
(EA) / Record of Decision (ROD)
(strikethrough irrelevant)
Services Report or indication of
all municipal services /
registered servitudes
Any additional documents or
information required as listed in
the pre-application
consultation form / minutes
Y
N
N/A
Other (specify)
Y
PART H: AUTHORISATION(S) IN TERMS OF OTHER LEGISLATION
Y
N/A
Y
N/A
Y
N/A
Y
N/A
Y
N/A
National Heritage Resources Act, 1999
(Act 25 of 1999)
National Environmental Management
Act, 1998 (Act 107 of 1998)
Subdivision of Agricultural Land Act,
1970 (Act 70 of 1970)
Spatial Planning and Land Use
Management Act, 2013 (Act 16 of
2013)(SPLUMA)
Occupational Health and Safety Act,
1993 (Act 85 of 1993): Major Hazard
Installations Regulations
Y
N/A
Specific Environmental
Management Act(s) (SEMA)
(e.g. Environmental Conservation
Act, 1989 (Act 73 of 1989), National
Environmental Management: Air
Quality Act, 2004 (Act 39 of 2004),
National Environmental Integrated
Coastal Management Act, 2008 (Act
24 of 2008), National Environmental
Management: Waste Act, 2008 (Act
59 of 2008),
National Water Act, 1998 (Act 36 of
1998)
Mineral & Petroleum Resources
Development Act, 2002
(strikethrough irrelevant)
Page 4 of 6
Land Use Planning Act, 2014 (Act 3 of
Y
N/A Other (specify)
2014) (LUPA)
If required, has application for EIA / HIA / TIA / TIS / MHIA approval been made? If yes, attach
Y
N
documents / plans / proof of submission etc.
If required, do you want to follow an integrated application procedure in terms of section
Y
N
43(1) of the Breede Valley Municipal Land Use Planning By - Law?
SECTION I: DECLARATION
Y
N/A
I hereby wish to confirm the following :
1.
That the information contained in this application form and accompanying documentation is
complete and correct.
2.
The Municipality has not already decided on the application.
3.
I’m aware that it is an offense in terms of section 83(1)(e) to supply particulars, information or answers
in an application, knowing it to be false, incorrect or misleading or not believing them to be correct.
4.
I am properly authorized to make this application on behalf of the owner and (where applicable)
copies of such full relevant Powers of Attorney/Consent are attached hereto.
5.
I have been appointed to submit this application on behalf of the owner and it is accepted that
correspondence from and notifications by the Municipality in terms of the by-law will be sent only to
me as the authorised agent and the owner will regularly consult with the agent in this regard (where
applicable).
6.
That this submission includes all necessary land use planning applications required to enable the
development proposed herein.
7.
I confirm that the relevant title deed(s) have been read and that there are no restrictive title deed
restrictions, which impact on this application, or alternatively an application for
removal/amendment/suspension forms part of this submission.
8.
I am aware of the status of the existing bulk services and infrastructure in the subject area and that I
am liable for any possible development charges which may be payable as a result of the proposed
development.
Applicant’s signature:
Date:
Full name:
Professional capacity:
SACPLAN Reg. Nr:
____________________________
Page 5 of 6
FOR OFFICE USE ONLY
Date received:
Received by:
Receipt number:
Date application
complete
ANNEXURES
The following Annexures are attached for your
information, only if applicable:
Please do not submit these Annexures with the
application form.
Annexure A: Application submission and
procedural requirements
Annexure B: Application submission checklist and
protocol
Page 6 of 6