This form will take approximately 10 minutes to complete. Please ensure you have enough time to complete the whole form in one session so that your data is not lost. You will need evidence of public liability insurance to the value of £10 million. This should be attached to the form by uploading it from the device you are using (computer, tablet). You will be invoiced a charge of £86.40 for the first 10 day period. There will be a charge of £40.10 for each additional 7 day period. The questions marked with an asterisk (*) are mandatory and require an answer. Applicant details Title Select or enter your title. Mr Mrs Miss Ms Mx Dr Other Other First name * Enter your first name. Last name * Enter your last name. Company house name/number Enter the address name or number. This could a flat, house or building name or number. Company address line 1 Enter the first line of the address. This could be the street name. Company address line 2 Enter the second line of the address if you need to. This could be the village name. Town/city Enter the town or city of the postal address. Postcode Enter the postcode, with or without spaces. Email address Enter an email address where we can write to you. Phone number Enter a daytime phone number that we can ring you on. This can be a mobile or land line number. Alternative phone number Enter another phone number we can reach you on. This can be a mobile or land line number. Type of application Select one of the options below. Cherry picker Scissor lift Renewal of existing licence Licence details Name of MEWP company Enter the name of the MEWP company. Proposed location of the MEWP Enter details of the proposed location. Location of the MEWP Select one of the options below. Verge Footway Carriageway Licence start date Enter the date when the licence is needed from following the format dd/mm/yyyy, for example 01/01/2015. Licence end date Enter the date when the licence is needed to following the format dd/mm/yyyy, for example 01/01/2015. Number of licences required Enter the number of licences you require for this location. Hours of operation Enter your hours of operation. MEWP kept outside of these times Enter details of where the MEWP is kept outside of your hours of operation. Site plan Attach a copy of the site plan. Third party liability and employers insurance certificate for a minimum of £10 million. Attach a copy of the contractor's third party liability insurance certificate. Is traffic management required to undertake this work? Select 'Yes' if this application requires traffic management. Yes No Traffic management required Select the traffic management that is required. Signing only Lane closure 2 way traffic lights 3 or 4 way traffic lights Terms and conditions The works - All works shall be in accordance with the specific requirements issued by WSCC at the time of the resident’s application and in so far as the site will be subject to periodic inspection, additional conditions may be imposed during the works. Traffic control - The executor of the works shall provide and erect all necessary warning notices, signs and signals for the satisfactory control of traffic in accordance with Chapter 8 – Traffic Signs Manual 1991, and the Traffic Signs Regulations and General Directions 1994 and any subsequent amendments thereof as directed by the Highway Network Manager. Health, safety and welfare - The executor of the works shall undertake works in accordance with the Health and Safety at Work Act 1974 and all other legislation, Approved Codes of Practice and Guidelines applicable to the works. This shall be done with particular regard to the protection of the public from harm, injury, damage or loss. Disabled and blind person - All works shall be executed with due regard to the additional particular needs of disabled and blind persons using the highway. Road signs - No existing road sign/line shall be obstructed or rendered less effective due to the execution of works without the approval of the Council and the provision of alternative signing/lining to his requirements. Default - In the event of the works not being to the entire satisfaction of the County Council the works shall cease and the original conditions shall be restored forthwith. If necessary, the restoration of works will be carried out by the County Council and the costs shall be recoverable from the person or persons responsible. It is the responsibility of the applicant to consult with the Local Planning Authority to determine whether a planning approval is required for these works. Declaration I/we hereby undertake to indemnify the West Sussex County Council, its officers, servants and agents against all costs, claims and expenses, damage to property and injury to persons howsoever caused arising directly or indirectly from the depositing of builder’s materials/skip bag(s) or works carried out in connection therewith. I/we hereby certify that I am/we are the owner(s)/deemed owner(s) of the mobile elevated working platform(s) and that I/we will comply with the conditions above. Your full name * Enter your full name to show you agree to the above statements. To send your form to us press the 'Submit' button once. After a few moments you will see our 'Thank you' page. If you do not see the 'Thank you' page we will not have received your form.