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Orkney Islands Area Licensing Board

Licensing (Scotland) Act 2005

Information regarding occupiers of land or buildings within 4 metres in any direction of any boundary of premises.

Premises
(full address including postal code)
Applicant

Details of any land or buildings within 4 metres in any direction of any boundary of the premises, providing postal address where relevant and details of any flats contained within the buildings, if relevant:

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2
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5
6

Continue on separate sheets if necessary.

Continued on next page.

IMAGE: Page 1 presents a blank two-page licensing form. The first page contains fields for the premises address and applicant, followed by six numbered blank entries for land or buildings within 4 metres of the premises boundary. It also states, “Continue on separate sheets if necessary.” and “Continued on next page.”

Details of occupiers of such land or buildings, to the best of the applicant’s knowledge, including contact postal address, where known:

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2
3
4
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6

Continue on separate sheets if necessary.

Applicant’s email address.
Applicant’s contact telephone number.
Date.

IMAGE: Page 2 continues the blank form with six numbered entries for the occupiers of nearby land or buildings, followed by fields for the applicant’s email address, contact telephone number, and date.