<p> APPLICATION FOR AN ANIMAL BOARDING ESTABLISHMENT LICENCE – HOME BOARDING</p><p>ANIMAL BOARDING ESTABLISHMENTS ACT 1963</p><p>I/We ...... </p><p>...... </p><p>Address ...... </p><p>...... </p><p>…………………...... Telephone ...... Email Address ...... </p><p>Age of applicant/s (if ...... under 18) as (proposed) occupier(s) of the premises hereinafter mentioned HEREBY MAKE APPLICATION in pursuance of Section 1 of the Animal Boarding Establishments Act 1963 for a LICENCE TO KEEP A HOME BOARDING ESTABLISHMENT (DOGS) at the premises of which particulars are given below.</p><p>I/WE ENCLOSE HEREWITH the sum of £171.00 being the amount of the fee payable on the Licence applied for.</p><p>THE MAXIMUM NUMBER OF DOGS TO BE KEPT AT THE PREMISES IS 3 (three) NO DOG REGISTERED UNDER THE DANGEROUS DOGS ACT 1991 OR ANY DOG THAT HAS A CONTROL ORDER PLACED ON IT BY A MAGISTRATES' COURT MUST BE ACCEPTED FOR HOME BOARDING</p><p>PARTICULARS 1 Postal Address of Premises ...... Telephone Number of Premises ...... 2 Number, construction and size of ...... quarters in which animals are (will . be) accommodated (internal construction only) ...... 3 Heating Arrangements ...... 4 Method of ventilation of premises ...... 5 Lighting arrangements - Natural ...... Artificial ...... 6 Water supply ...... 7 Arrangement for food storage ...... 8 Arrangements for disposal of ...... excreta ...... 9 Description of isolation facilities for ...... the control of infectious disease ...... 10 Type of exercise facilities available ...... </p><p>Are you disqualified from:</p><p>(a) keeping a dog breeding establishment? YES/NO (b) keeping a pet shop? YES/NO (c) keeping a dog? YES/NO (d) keeping custody of animals? YES/NO (e) keeping an animal boarding establishment? YES/NO</p><p>Please state the maximum number of animals you intend to keep at DOGS: .... the premises: ....</p><p>Opening times of premises ...... am ...... pm Please give the name and address of ...... your usual Veterinary Surgeon: ...... </p><p>Please state any times in the next 4 weeks when the premises will not be available for inspection</p><p>...... </p><p>Data Protection Act 1998 This information is required for the processing of applications under the Animal Boarding Establishments Act 1963. Information provided on the form will be shared with the relevant consultees, including Cornwall Councillors and Members of the Council's Licensing Committee and other organisations as the law allows (these other organisations include government departments and local authorities, for the purposes of preventing or detecting crime or to protect public funds). Information will be held both manually and electronically and will not be kept for longer than is necessary.</p><p>I agree to permit an Officer, Veterinary Surgeon or Veterinary Practicitioner authorised by the Council to inspect the premises which are the subject of this application before any Licence is granted.</p><p>I/WE DO HEREBY DECLARE that to the best of my/our knowledge and belief, the above particulars are true.</p><p>Dated this ...... day of ...... 2016 Signed: ...... </p><p>FOR OFFICE USE ONLY</p><p>Premises inspected by Date</p><p>Accompanying Vet (if any)</p><p>Please return this form along with the above to:</p><p>Licensing, Cornwall Council 2nd Floor, East Wing Dolcoath Avenue Camborne , TR14 8SX Tel: 01209 615055 Email: [email protected]</p>