FORM 5
NOTICE OF OBJECTION TO THE GRANTING OR RENEWAL OR VARIATION OR TRANSFER* CF A LICENCE OR VARIATION OR CANCELLATION
OF A TERM OR CONDITION OF AN EXEMPTION PURSUANT TO SECTION 14/16/18/18A/23* OF THE AIR POLLUTION CONTROL ORDINANCE
eg.19
To: The Authority
1.
Full Name of Objector:
2.
Home Address of Objector:
Cffice Address of Objector:
Occupation:
Telephone No.:
3. Details of the Application Under Objection:
Registration No.:
Name of Applicant:
Purpose of the Application:
Address of the Premises Where the Specified Process Is To Be Conducted:
4. Relevant Air Quality Objective(s) being Threatened:
5. The grounds for this objection are: (set them out in full)
Dated this
4
day of
(Signature)
Objector
of 19
Copy to the Secretary for Health and Welfare
* Delete if not applicable