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Consent No..............
APPLICATION FOR CONSENT TO DEPOSIT A BUILDER’S SKIP
Roads (Northern Ireland) Order 1993 - Articles 96 and 97
Roads (Control of Builders' Skips) Regulations (Northern Ireland) 1981 Regulation 4
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To: The Divisional Roads Manager
Division
I/We, the undersigned, hereby make application for consent to deposit a builder's skip as shown below and it is
agreed that:(1) The skip will be removed on or before the end of the period mentioned or prior to this if the Police or the
Department so request.
(2) The skip shall be deposited in accordance with the provisions of Articles 96 and 97 of the Roads (Northern
Ireland) Order 1993 and the Roads (Control of Builders' Skips) Regulations (Northern Ireland) 1981.
Name (Block Letters)...............................................
Signed.............................................
Address..................................................................... Date.................................................
................................................................................... Telephone Number..........................
…………………………Post Code …………..…...
________________________________________________________________________
PARTICULARS
1.
Address of premises where works are taking place
.............................................................................………………………………………......
................................................................................................................................................
2. Precisely where skip is to be placed (attach sketch if necessary)
...........................................................…………………………………………………….....
................................................................................................................................................
3. Period:
4.
From.....................................
To.....................................
Name and Address of Owner of Skip
…......................................................................................................………………………..
................................................................................................................................................
Telephone Number ...................…................
Fax Number.........................................
________________________________________________________________________
FOR OFFICE USE ONLY (To be completed by Divisions)
Agreed issue consent:
Period of Consent:
YES/NO
From.....................................
Alternative Site...........................................
To .............................….........
Address of nearest Police Station .....................……...........................................................
……………………………………………...........................................................................
Subject to any conditions stated overleaf
Signed .........................................................
Date .........................................................