SKIP PERMIT EALING COUNCIL Customer Services First Floor Perceval House 14-16 Uxbridge Road Ealing W5 2HL DIRECT LINE: 020 8825 6000 FAX: 020 8825 5553 IMPORTANT NOTICE PERMITS WILL NOT BE ISSUED TO ANY PERSON IF THE SKIP COMPANY THEY PROPOSE TO USE HAS NOT BEEN REGISTERED WITH EALING COUNCIL (1) DETAILS OF APPLICANT (SEE NOTE; 1 & 2) SURNAME _____________________________________________ FORENAME ____________________________________________ ADDRESS _____________________________________________________________________________________________________ POST CODE ___________________________________________ TEL NO ________________________________________________ (2) SITE PARTICULARS SITE ADDRESS ________________________________________________________________________________________________ PLEASE STATE IF SITE IS IN A CONTROLLED PARKING ZONE AREA (CPZ) YES/NO NUMBER OF SKIP(S) (IF MORE THAN 1 SKIP IS REQUIRED ON A SITE - SEE NOTE 6) _________________ PERIOD OF SKIP(S) (MAXIMUM IS 1 CALENDAR MONTH – SEE NOTE 10) _______________________________________________ DATE FROM ____________________________________ DATE TO ______________________________________________________ (3) DETAILS OF SKIP COMPANY: PERMITS WILL NOT BE ISSUED WITHOUT THE FOLLOWING DETAILS SKIP COMPANY NAME __________________________________________________________________________________________ ADDRESS _____________________________________________________________________________________________________ ________________________________________________ TEL NO ________________________________________________ SIGNATURE OF APPLICANT (SEE ALL NOTES ON REVERSE) __________________________________________________________ I THE SIGNATORY BELOW, AGREE TO COMPLY WITH THE PROVISIONS OF SECTION 139 & 140 OF THE HIGHWAY ACT 1980. I ACCEPT THE RESPONSIBILITY FOR THE SKIP WHEN ON THE HIGHWAY, AND IN PARTICULAR FOR THE LIGHTING OF THE SKIP DURING THE HOURS OF DARKNESS. I ALSO ACCEPT CONDITIONS IMPOSED BY SKIP COMPANIES REGARDING THE ABOVE RESPONSIBILITIES. I FURTHER ACCEPT RESPONSIBILITY FOR ANY COST INCURRED BY EALING COUNCIL DUE TO MY FAILURE TO COMPLY WITH ANY OF THESE CONDITIONS. SIGNATURE OF APPLICANT ______________________ FULL NAME IN BLOCK CAPITALS __________________________________ STATUS OF SIGNATORY EG. BUILDER, HOUSE OWNER ETC (SEE NOTE 2 ON REVERSE) ___________________ Payment Type (Please Tick): Cash Credit/Debit Card Cheque Postal Order Details of Payment Methods Overleaf FOR OFFICE USE ONLY RECIEPT NUMBER _______________________ PAYMENT ___________________ DATE RECEIVED _________________________ PERIOD AGREED FROM ______________________ TO _______________________________________________________________ AUTHORISED SITE _____________________________________________________________________________________________ OFFICER _________________________ DATE _________________ AREA ___________________ PERMIT NO __________________ Notes for applicant 1 If an applicant is an individual, please insert the Applicant’s full name and address. If the applicant is a company, please insert the Company’ full name and address. 2 The applicant and signatory must be the same person. When the applicant is a Company, the position in the Company of the signatory is to be also inserted. 3 Applications for skip permits must be made on this form 4 No skips can be allocated on a pay & display. 5 The fee for a skip permit is £20 per skip. If you live in a CPZ you will be required to pay an additional £10.00 per skip. No refunds will be given. 6 If more then 1 skip is required on a site, the application must be checked and agreed by an enforcement officer before the permits are granted. 7 To renew your skip permit application you will be required to complete another form and pay the relevant fees. 8 The person signing the application form (Skip Permit Holder) is responsible for the following: Ensuring the skip is sited as directed on the permit. Ensuring the contents of the skip are not allowed to fall onto the highway. Ensuring the skip is lit during the hours of darkness. Ensuring the skip is removed when the permit expires. Ensuring the highway in the vicinity of the skip is kept clean and tidy at all times. 9 Lights on skips that are stolen are to be reported to the police. 10 Inspections are carried out periodically both during the daytime and after lighting up time. Persons found not to comply with the conditions of the permit will be subject to costs incurred and reported to Ealing Council’s Legal Services for action to be taken. 11 The permit will be valid for one calendar month from the date specified on the permit and a new application is required if a skip is to remain on the public highway after this time. New renewal applications should be made at least 3 working days prior to the existing permit expiry. 12 Applications take approximately 48 hours to be processed, enquiries for permit numbers Monday to Friday on 020 8825 6000 Payment details BY POST: This form together with a cheque, postal order or contact telephone number for credit or debit card payment, should be posted to: Ealing Council, Customer Services, Multi-Media Team, First Floor, Perceval House, 14-16 Uxbridge Road, Ealing, W5 2HL. BY FAX: 020 8825 5553 IN PERSON: Cash payments, cheques, credit or debit cards and postal orders can be taken to: Ealing Council Reception, Perceval House, 14-16 Uxbridge Road, Ealing W5 2HL Cheques and Postal orders should be made payable to Ealing Council. Please note: NO Credit or Debit Card details should be entered on this form.