Isle of Wight Council

Application For The Grant/ Transfer/ Renewal Of A Licence To Use Land As A Site For Movable Dwellings

The following documents regarding this form are available by clicking the links below: Guidance Notes Licence conditions for touring caravan sites for the former Borough of South Wight Licence conditions for camping sites (tents) for the former Borough of South Wight Licence conditions for touring caravan sites for the former Borough of Medina Licence conditions for tent sites for the former Borough of Medina

I/We hereby apply for the [grant][transfer][renewal] (delete as appropriate) of a Licence under Section 269 of the Public Health Act 1936 to use the land described below and shown on the attached plan (see note below) as a site for moveable dwellings to be used and laid out as specified below. For applications for new licences or for the alteration of licences a lay-out plan of the site to a scale of not less than 1/500 showing boundaries of the site, the positions of caravan standings, and, where appropriate: roads and footpaths; toilet blocks, stores and other buildings; water supply; recreation spaces; fire points; parking spaces, will be requested. The plan should distinguish between facilities already provided and facilities proposed.

Applicant Details

First Applicant

	Title
*	Forename
	Middle name/Initials
*	Surname

*	Building/house name/number
*	Street address
*	Town name
	County
*	Postcode
	Telephone number (include area code)
	Email address

Second Applicant

	Title
	Forename
	Middle name/Initials
	Surname

	Building/house name/number
	Street address
	Town name
	County
	Postcode
	Telephone number (include area code)
	Email address

	Site Details
	Address or description of site for which licence is required:

*	Building/house name/number
*	Street address
*	Town name
	County
*	Postcode
	Telephone number (include area code)
	Email address
	Fax

*	Is the application for a:	new licence transfer of licence amendment/renewal of existing licence
*	Acreage of site

*	Has the applicant(s) held a site licence which has been revoked at any time in the last 3 years?	Yes No
	If yes, please give details
*	State maximum number of movable dwellings proposed to be stationed on the site at any one time.
*	Description of movable dwellings proposed to be stationed on the site.

Give details of the arrangements for the following:

*	Water supply
*	Washing facilities

	Sanitary provision:	Closet accommodation
*		Disposal of refuse
		Disposal of wastewater

*

Refuse disposal

	About Planning Permission
*	Has planning permission for the site been obtained from the local planning authority? Yes No If so, state: (a copy of Planning Permission may be requested)

	Date of permission
	Planning permission number
	Issuing authority
	Date (if any) on which permission will expire
	If planning permission has not been obtained, has permission been applied for?	Yes No

	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