Application to change an environmental permit from East Staffordshire Borough Council

Step 2 of 4 Submit the application

Email address

Please provide your email address, so the licensing authority can let you know if your application has been successful or not.

Email address Confirm email address

Application form

Please attach the completed application form below.

Application form

Supporting documents

All documents are required, unless stated otherwise. Photos of documents are acceptable, as long as all the relevant information is clear. We'll only share these documents with the licensing authority.

Maximum size allowed per file is 10 MB.

We only allow the following file types : doc, docx, gif, jpeg, jpg, pdf, png, ppt, pptx, rtf, txt, xls, xlsx

What if I can't submit all of these documents?

You don't have to submit optional documents, but it may improve your chances of a successful application if you do.

What if I can't submit the documents digitally?

If you can't submit the documents digitally you can send copies by post instead. We'll give you the address and reference number to quote once you've paid the licence fee.

OK, I'll submit all the documents by post instead

Site Map 1: Location of the Installation
Clearly define extent of the installation in red and indicate the extent of the installation affected by the proposed change.

Site Map 2: Layout of Activities on site
location for bulk storage of materials, waste storage & external emission points to atmosphere, indicating activities that will be affected.

Declaration by Operator of Previous Offences
Signed declaration from the operator to certify No previous offences committed or previous offences have been committed with details attached.

Site Map 3: Discharges to Water (Mandatory for A2) (optional)
Plan of site drainage system and all discharge points to drainage or water courses, indicating which will be affected by the proposed change.

Evidence of Authority (optional)
Evidence of authority is mandatory from the board of the company or body corporate required where the operator is a company or other body corporate.

Declaration

I/We certify that the variation fee has been calculated in liaison with the Local Authority.
I/We certify that a 'Previous Offences Declaration' has been signed & attached with this application using either of the following wording as applicable: No offences have been committed in the previous five years which are relevant to my/our competence to operate this installation in accordance with the Regulations. OR The following offences have been committed in the previous five years which may be relevant to my/our competence to operating this installation in accordance with the Regulations.
I/We have read and understood the Section of the application form relating to commercial confidentiality. I/We understand that the information we provide will be used by the Local Authority to process my/our application and that the information will be placed on the relevant public register (subject to any request for commercial confidentiality) and used to monitor compliance with the permit conditions.
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: Individual operators must sign the declaration themselves, even if an agent is acting on their behalf).

Ticking this box indicates you have read and understood the above declaration

By continuing, you're giving the Cabinet Office permission to pass the information you're supplying to the relevant authority.

For more details on how your information is used please refer to the Government Digital Service privacy notice (opens in new tab) and East Staffordshire Borough Council.