Sch 1

Schedule 1 Application for a licence for an approved kennel establishment [Clause 4.2] I/we (full name) ............................................................................................................................................ of (postal address) ........................................................................................................................................ (telephone number) ...................................................................................................................................... (facsimile number) ....................................................................................................................................... (E-mail address) ........................................................................................................................................... Apply for a licence for an approved kennel establishment at (address of premises) ................................ ....................................................................................................................................................................... For (number and breed of dogs) ...................................................................................................................

• (insert name of person) ............................................................ will be residing at the premises on and from (insert date) ...............................................
• (insert name of person) .................................................. will be residing (sufficiently close to the premises so as to control the dogs and so as to ensure their health and welfare) at ................................ .......................................... ............................................................................... (insert address of residence) on and from ....................................... (insert date). Attached are— (a) a site plan of the premises showing the location of the kennels and yards and all other buildings and structures and fences; (b) plans and specifications of the kennel establishment; (c) copy of notice of proposed use to appear in newspaper; (d) copy of notice of proposed use to be given to adjoining premises; (e) written evidence that a person will reside— (i) at the premises; or (ii) sufficiently close to the premises so as to control the dogs and so as to ensure their health and welfare; and (f) if the person in item (e) is not the applicant, written evidence that the person is a person in charge of the dogs. I confirm that I have read and agree to comply with the Code of Practice known as .............................. , .................................................................. in the keeping of dogs at the proposed kennel establishment. Signature of applicant ....................................................... Date .......................................