Licensing Authority

Mid Devon District Council

Phoenix House, Phoenix Lane

Tiverton, Devon, EX16 6PP

Tel: 01884 244617/8/9

 

 

 

Animal Boarding Establishments Act 1963

 

Application for Licence to keep a Boarding Establishment for Animals

  

FOR OFFICE USE ONLY

 

Date copied to Vet/EHO:

 

Date of Inspection:

Licence No:

Received:

 

Recommendation:

Issued:

 

 

 

Please complete in block capitals or type.  In all cases ensure that your answers are inside the boxes and written or typed in black ink. Use additional sheets if necessary.  You may wish to keep a copy of the completed form for your records.

 

1. YOUR PERSONAL DETAILS

FIRST APPLICANT

TITLE 

Surname

  

Forenames

I am 18 years old or over. 

Yes

No

 

ADDRESS WHERE ORDINARILY RESIDENT

 

Post town 

Post code

TELEPHONE NUMBERS

Daytime

Evening

Mobile



FAX NUMBER  

E-MAIL ADDRESS

SECOND APPLICANT (if applicable)

TITLE  

Surname

  

Forenames

I am 18 years old or over. 

Yes

No

 

ADDRESS WHERE ORDINARILY RESIDENT

 

Post town

 

Post code

 

TELEPHONE NUMBERS

Daytime

Evening

Mobile



FAX NUMBER  

E-MAIL ADDRESS

Payment Method On-Line                            By Cheque 

     If Payment is to be made by cheque we cannot process this application until it is received.

 

 

2. BOARDING ESTABLISHMENT PARTICULARS

                                                                                                                        

Name and address of Boarding Establishment

Post Code

Telephone No

Type of Boarding Establishment Purpose-built kennels              In your own homes domestic quarters 

 

a) Please detail the number of quarters in which animals are/will be accommodated and maximum number of animals.

 

 

b)  Specify the size of the quarters (layout/exercise area).

 

 

c)  Please detail the construction of quarters (walls/partitions/ floors/ceilings/doors/windows).

 

 

d)  Please describe the heating arrangements.

 

 

e)  What ventilation arrangements are in place?

 

 

 

 

f)  What arrangements are in place for drainage and disposal of excreta?

 

g)  Please give details of lighting arrangements (natural/artificial).

 

 

h)  Please give details of water supply facilities.

 

 

i)  Describe what arrangements you have for food storage.

 

 

j)  What kitchen facilities are available for food preparation?

 

k)  Please provide a description of isolation facilities for the control of infectious diseases.

 

l)  Please describe your accident emergency plan and fire safety precautions on site.

 

m)  Name, Address and Tel No of usual Veterinary Surgeon

 

 

 

I/WE HEREBY DECLARE that I/we am/are over 18 years of age and not disqualified by being convicted of any offence at any time under the Protection of Animals Act 1911; the Pet Animals Act 1951; the Animal Boarding Establishment Act 1963; or the Animal Welfare Act 2006 under sections 4, 5, 6 (1) & (2), 7 to 9 and 11.

 

I/WE HEREBY APPLY for a licence to keep an animal boarding establishment and enclose the appropriate licence fee and a current certificate of insurance.

 

I/WE DO HEREBY CERTIFY that to the best of my/our knowledge and belief, the particulars contained in this application are correct and true.  

 

 

Name (1st Applicant)           Date:

 

Capacity if applicant(s) sign on behalf of a Company or Partnership

 

Name (2nd Applicant)          Dated

 

Capacity if applicant(s) sign on behalf of a Company or Partnership

 

Human Check:

 

 

THIS APPLICATION MUST BE ACCOMPANIED BY THE APPROPRIATE FEE

 

 

 

This Authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud.  It may also share this information with other bodies responsible for auditing or administering public funds for these purposes.  For further information, see www.middevon.gov.uk/index.cfm?articleid=3746 or contact the Information Management and e-gov Officer on 01884 234916.