In accordance with section 2 of the above Act this form may not be submitted to the local authority until at least two months after submission of the required notice of intention to make application for a zoo licence to the local authority; of publication of that intention in one local and one national newspaper; and of exhibition of a copy of the press notice at the site of the proposed zoo.

I/WE (Full Name)

Of (address)

Post Code      Tel No

in accordance with, and following publication of, the notice of intention 
Publication Date



[insert the date of publication of the notice of intention and the names of one local and one national newspaper in which the notice appeared]
hereby apply to Mid Devon District Council for a licence to operate the zoo referred to in that notice.
Any significant changes in the information supplied in paragraph 2 of the notice to the local authority of intention to apply for a licence of the proposed zoo to be set out below. 

Have you, or has anybody employed by you as a keeper, ever been convicted of an offence under the following  enactments:-
The Zoo Licensing Act 1981
The Protection of Animals Act 1911 to 1964
The Protection of Animals (Scotland) Acts 1912 to 1964
The Pet Animal Act 1951
The Protection of Birds Acts 1954 to 1967
The Animal Boarding Establishment Act 1963
The Riding Establishments Act 1964 to 1970
The Breeding of Dog Act 1973
The Conservation of Wild Creatures and Wild Plants Act 1975
The Dangerous Wild Animals Act 1976
The Endangered Species (Import and Export ) Act 1976
Or of any other offence involving the ill treatment of animals? YES         NO

If Yes please give details:

Additional Matters

Set out below any other matters (if any) which you would like to bring to the attention of the local authority .


I enclose a fee of £50.00 (paid online    Cheque by post   ) and agree to pay the costs incurred for veterinary inspection

Signed   Date 

Intended Zoo Operator

Note: The ‘original zoo licence’ is granted for a period of four years. An inspection will be carried out by a veterinary

surgeon (nominated by the Department of Environment, Transport and the Regions) at the beginning of the four year

period and not later than six months before the end of the fourth year. A renewed licence is of six year duration and two

inspections would take place in that period.

Human Check: