Application Form - Licence to keep an Animal Boarding Establishment

Name/s of Applicant/s

Title *

First Name

Surname *

Address of Premises *

Address of Premises

Postcode *

Telephone Number

E-mail Address

Type of Premises *

The maximum number of animals to be kept at any one time:

Dogs

Cats

I enclose a remittance of £102.50 for the licence fee (Cheques and Postal Orders to be made payable to North East Lincolnshire Council)

Signed 1	Dated	Signed 2	Dated
Signed 1	Dated Month Day Year	Signed 2	Dated Month Day Year

Please use the submit button to generate the PDF printed form. Sign the form and return together with said fee to the following address;

Environmental Services, Freeman House, Freeman Way, Grimsby, North East Lincolnshire, DN32 7AU

For any queries please telephone (01472) 324770

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