For Office Use Only	
Receipt No.:		
Fee:		
Date:		

KIRKLEES COUNCIL
APPLICATION FOR PERMIT FOR STREET BASED ACTIVITY
IN STREETS AND PUBLIC PLACES
PARTICULARS OF ACTIVITY

Completed applications must be received at least 10 working days prior to the activity, as applications received within this period may not be processed.

1	Full name of Applicant:	Mr/Mrs/Miss	
2
	Full address of Applicant:

	
	Post code:		Tel No.		
	e-mail address		
3	Name and address of Organisation for which the permit is required	
	Name of Organisation		
	Address

	
	Post code:		Tel No.		
3a	What is the nature of the organisation:

3b	What is the nature of the promotion:

4	At which location and in which town in the Kirklees area is it proposed that the street based activity will take place: 		
5	What date(s) is it proposed that the activity should be made:		
	Between what times do you intend to undertake the activity?	                   to	

	If the first choice is unavailable please give an alternative date(s):		
6	Do you wish consideration to be given, to park any caravan, display vehicles or erect a table or display?	Yes/No	
	If yes, please state location:		
	Type of display:		
	Vehicle Registration No.		
	Please provide photographs of the Caravan/vehicle/gazebo to be used 	
7	How many Agents are you proposing to undertake the activity?
(Please Note Direct Debit activities are restricted to three per day)		
8	Does the activity involve the collection of any monies either directly or indirectly?	Yes/No	

Checklist	Tick if enclosed	
Photographs of Caravan/vehicle/gazebo to be used		

Signed:		Name:		
Position in Society:		Date:		

Personal Data

We have recently updated our Privacy Notice about how we use personal data provided to the Council. Further information can be found at:

http://www.kirklees.gov.uk/beta/information-and-data/pdf/privacy-notice-other-licenses.pdf

Please note: Depending on the nature of the Activity there may be a charge.
This application should be returned to:
Licensing Department
Kirklees Council
Flint Street Depot
Flint Street
Huddersfield
HD1 6LG

Tel: 01484 456868

PLEASE NOTE - YOU MAY BE REQUIRED TO PROVIDE DOCUMENTS TO THE COUNCILS DUTY ENFORCEMENT OFFICERS ON THE DAY(S) OF ACTIVITY