Lisburn Online Forms - PPC Permit Application

A.1 Name of the installation:

Street Number and Name:

City or Town:

Post Code:

Country:

Telephone No:

+

Please give details of any existing LAPC or IPC authorisation for the installation, including reference number(s):

Company name:

Trading/business name (if different):

Street Number and Name:

City/Town:

Postcode:

Country:

Street Number and Name:

City/Town:

Postcode:

Country:

Company registration number:

Is the operator a subsidiary of a holding company within the meaning of the Companies (Northern Ireland) Order 1986?:

No
Yes

Name of ultimate holding company:

Street Number and Name:

City Town:

Postcode:

Country:

Company Registration Number:

Name:

Position:

Street number and name:

City Town:

Postcode:

Country:

Telephone Number:

Fax Number:

Email Address:

Column 1a - Activities in the Stationary Technical Unit:

Column 2a - Schedule 1 References:

Column 1b - Directly associated activities:

Column 2b - Schedule 1 References:

Doc Reference - map:

Doc Reference - plan:

Doc Reference - installation and activities:

Doc Reference - Emission Identified:

Doc Reference - proposed systems:

Doc Reference - proposed measures:

Doc Reference - procedures & policies:

Doc Reference - assessment:

B3.2 Are there any areas of special scientific interest (ASSIs) or European Sites which are within 2 kilometres of the installation?:

No
Yes

Please give names of the sites:

Doc Reference - Conservation:

B4.1 Has an environmental impact assessment been carried out under Council Directive 85/337/EEC, or for any other reason with respect to the installation?:

No
Yes

4.1 - please supply a copy of the environmental impact assessment and details of any decision made Doc reference:

Please supply any additional information that you would like us to take account of in considering this application - Doc reference:

Fee:

Please give any company purchase order number or other reference you wish to be used in relation to this fee:

Street Number and Name:

City or Town:

Post Code:

Country:

Telephone No:

+

Is there any information in the application that you wish to justify being kept from the public register on the grounds of commerical confidentiality?:

No
Yes

Please provide full justification, considering the definition of commerical confidentiality within the PPC Regulations. Doc Reference:

Is there any information in the application that you believe should be kept from the public register on the grounds of national security?:

No
Yes

Installation name:

Name:

Position:

Date:

Name:

Position:

Date:

Fees:

A.1 Name of the installation:
A1.2 Please give the address of the site of the installation
Street Number and Name:
City or Town:
Post Code:
Country:
Telephone No:	+
A1.3 Existing authorisations:
Please give details of any existing LAPC or IPC authorisation for the installation, including reference number(s):
Please provide the information requested below about the "Operator", which means the person who it is proposed will have control over the installation in accordance with the permit (if granted)
A2.1 The Operator - Please provide the full name of company or corporate body
Company name:
Trading/business name (if different):
Registered Office address
Street Number and Name:
City/Town:
Postcode:
Country:
Principal Office address (if different)
Street Number and Name:
City/Town:
Postcode:
Country:
Company registration number:
A2.2 Holding Companies
Is the operator a subsidiary of a holding company within the meaning of the Companies (Northern Ireland) Order 1986?:	No Yes
Name of ultimate holding company:
Registered Office Address
Street Number and Name:
City Town:
Postcode:
Country:
Company Registration Number:
A3.1 Who can we contact about your application?
See A3.1 notes
Name:
Position:
Street number and name:
City Town:
Postcode:
Country:
Telephone Number:
Fax Number:
Email Address:
B1 About the Installation
See B1 notes
B1.1 Installation Table for New Permit Application
Please fill in the table below with details of all the current activities in operation at the whole installation.
Column 1a - Activities in the Stationary Technical Unit:
Column 2a - Schedule 1 References:
Column 1b - Directly associated activities:
Column 2b - Schedule 1 References:
B1.2 Site Maps
See B1.2 notes
Doc Reference - map:
Doc Reference - plan:
B2 The Installation
Please provide information about the aspects of your installation listed below and in the notes:
See B2 Installation notes
B2.1 Describe Installation and Activities
Doc Reference - installation and activities:
B2.2
See B2.2 notes
B2.3 - Describe techniques for reducing emissions:
See B2.3 notes
Doc Reference - Emission Identified:
B2.4 - Describe system for dealing with unintentional releases:
See B2.4 notes
Doc Reference - proposed systems:
B2.5 - Describe proposed monitoring methods:
See B2.5 notes
Doc Reference - proposed measures:
B2.6 - Provide details of Environmental Management techniques:
See B2.6 notes
Doc Reference - procedures & policies:
B3 Impact on the Environment
B3.1 - Provide an Environmental Impact Assessment:
See B3.1 notes
Doc Reference - assessment:
B3.2
B3.2 Are there any areas of special scientific interest (ASSIs) or European Sites which are within 2 kilometres of the installation?:	No Yes
Please give names of the sites:
B3.3 - Provide details of likely effect of installation on ASSI:
See B3.3 notes
Doc Reference - Conservation:
B4 - Environmental Statements
B4.1 Has an environmental impact assessment been carried out under Council Directive 85/337/EEC, or for any other reason with respect to the installation?:	No Yes
4.1 - please supply a copy of the environmental impact assessment and details of any decision made Doc reference:
B5 Additional Information
Please supply any additional information that you would like us to take account of in considering this application - Doc reference:
C1 Fees and Charges
See C1 notes
C1.1
Please state the amount enclosed as an application fee for this installation. We will confirm receipt of this fee when we write to you acknowledging your application.
Fee:
C1.2
Please give any company purchase order number or other reference you wish to be used in relation to this fee:
C2 Annual charge
If we grant you a permit, you will be required to pay an annual subsistence charge, failure to do so will result in revocation of your permit and you will not be able to operate your installation
C2.1
Please provide details of the address you wish invoices to be sent to and details of someone we may contact about fees and charges within your finance section
Street Number and Name:
City or Town:
Post Code:
Country:
Telephone No:	+
C3 Commercial Confidentiality
C3.1
Is there any information in the application that you wish to justify being kept from the public register on the grounds of commerical confidentiality?:	No Yes
Please provide full justification, considering the definition of commerical confidentiality within the PPC Regulations. Doc Reference:
C3.2
Is there any information in the application that you believe should be kept from the public register on the grounds of national security?:	No Yes
Do not write anything about this information on the form. Please provide full details on separate sheets, plus provide a copy of the application form to the Secretary of State for a Direction on the issue of National Security.
C4 Data protection
See C4 notes
C5 Declaration
C5.1 Name of current operator(s)*
See C5.1 notes
I/We certify that the information in this application is correct. I/We apply for a permit in respect of the particulars described in this application (including supporting documentation) I/We have supplied. Please note that each individual applicant must sign the declaration themselves even if an agent is acting on their behalf. For the application form:
Installation name:
Name:
Position:
Date:
Name:
Position:
Date:
* Where more than one person is defined as the operator, all should sign. Where a company or other body corporate - an authorised person should sign and provide evidence of authority from the board of the company or corporate body
Fees: