Isle of Wight Council

APPLICATION FOR A LICENSE TO PLACE SCAFFOLD/HOARDING ON THE PUBLIC HIGHWAY

Six copies to be return to: Environment Services Enterprise House St Cross Business Park Monks Brook Newport Isle of Wight PO30 5WB

1) SCAFFOLD/HOARDING COMPANY

Title

	Forename
	Middle name/Initials
	Surname

	Building/house name/number
	Street address
	Town Name
	County
	Postcode
	Home Tel Number (include area code)
	Office Tel Number (include area code)
	Out of hours telephone number

* PLEASE SELECT THE APPROPRIATE OPTION WHERE APPLICABLE THROUGHTOUT THIS FORM

2) Builder/hirer

Name

	Building/house name/number
	Street address
	Town Name
	County
	Postcode
	Home Tel Number (include area code)
	Daytime Tel Number (include area code)
	Evening tel. number

3. Location

	Give precise location where the scaffold/hoarding will be placed (i.e. number/name of property and road/street/town)

	4) Lighting
	Tick appropriate box

Liability for the lighting of the scaffold/hoarding shall be accepted by

Owner Hirer

	5) Period of license
	Give dates on which the license is to start and finish

	From:
	To:

A notice of 7 clear working days must be given with allowance for weekends and public holidays PLEASE NOTE: You will be invoiced for ................ for the attached permit. The invoice will be sent out at the end of each month

6) Declaration

I hereby apply for permission to place a builder's skip on the public highway and have read and accept the conditions  attached. Signature................................................................ Date........................................................................

Licence (to be completed by the issuing authority)

No: R2590/ / has been granted for the placing of a scaffolding/hoarding on the highway at the above location for the period shown. Conditions.................................................................................................................... ................................................................................................................................... ................................................................................................................................... Signature..................................................................... Date............................................................................

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy. Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013