Lisburn Online Forms - Petroleum Licence Application

Title:

First Name:

Last Name:

E-mail:

Main telephone number:

+

Other telephone number:

+

Street Number and Name:

City or Town:

Post code:

Country:

Are you applying as a business or organisation?:

YesNo

Is your business registered in the UK with Companies House?:

YesNo

Is your business registered outside the UK ?:

YesNo

Registration Number:

Legal Status:

Legal Status - other:

Your position in the business:

Premises Name:

Street Number and Name:

City or Town:

Postcode:

Country:

Type of Application:

Existing Licence Number:

Expiry date of existing licence:

Please list any structural alterations that have been made affecting petrol storage since issue of previous licence:

Name of premises or trading name:

Street name and number:

City or Town:

Postcode:

Description of premises:

Distance from nearest residential accomodation:

Control of petroleum deliveries (tick one):

Licensee controlled deliveries
Driver controlled deliveries

Timing of petroleum deliveries (please tick one):

Daylight deliveries only
24 hour deliveries

Reason for petroleum storage (please tick all that apply):

Sale to the public
Manufacturing purposes
Private use

Mode of delivery to the public (if applicable):

Attended service
Self service

Number of electrical pumps:

Number of manually operated pumps:

Total capacity of Petroleum Spirit in Tanks (litres):

Number of tanks:

Tank Type:

Above Ground
Underground

Construction Material:

Date installed:

Grade of Petroleum Spirit:

Tank capacity:

Add another tank:

Yes
No

If Yes, input information for additional tanks:

Please give the maximum amount (litres or kg) of other products stored and method of storage:

Please provide any additional required information (see guidance notes):

Fees:

I hereby apply to Lisburn City Council pursuant to::

I would confirm that the details that I have given are correct

Section 1 : Applicant Details
Title:
First Name:
Last Name:
E-mail:
Main telephone number:	+
Other telephone number:	+
Street Number and Name:
City or Town:
Post code:
Country:
Your Business
Are you applying as a business or organisation?:	YesNo
If you answer no please go to Section 2
Is your business registered in the UK with Companies House?:	YesNo
Is your business registered outside the UK ?:	YesNo
Registration Number:
Legal Status:
Legal Status - other:
Your position in the business:
Business address (if different from above)
Premises Name:
Street Number and Name:
City or Town:
Postcode:
Country:
Section 2: Type of Application
Type of Application:
Existing Licence Number:
Expiry date of existing licence:
Please list any structural alterations that have been made affecting petrol storage since issue of previous licence:
Section 3: Premises or site for which the licence is required
Name of premises or trading name:
Address (if diferent from above)
Street name and number:
City or Town:
Postcode:
Description of premises:
Distance from nearest residential accomodation:
Section 4: Petroleum deliveries and service
Please provide the following information about your petroleum deliveries and service
Control of petroleum deliveries (tick one):	Licensee controlled deliveries Driver controlled deliveries
Timing of petroleum deliveries (please tick one):	Daylight deliveries only 24 hour deliveries
Reason for petroleum storage (please tick all that apply):	Sale to the public Manufacturing purposes Private use
Mode of delivery to the public (if applicable):	Attended service Self service
Number of electrical pumps:
Number of manually operated pumps:
Section 5: Petroleum spirit stored in tanks
Total capacity of Petroleum Spirit in Tanks (litres):
Number of tanks:
Details about each Tank
Tank Type:	Above Ground Underground
Construction Material:
Date installed:
Grade of Petroleum Spirit:
Tank capacity:
Add another tank:	Yes No
If Yes, input information for additional tanks:
Section 6: Other products stored
Please give the maximum amount (litres or kg) of other products stored and method of storage:
Section 7: Additional details
Please provide any additional required information (see guidance notes):
Fees:
Section 8: Declaration
I hereby apply to Lisburn City Council pursuant to::	I would confirm that the details that I have given are correct