Road Closure Permit Application Form

ROAD CLOSURE PERMIT

APPLICATION FORM

ALL ROAD CLOSURE APPLICATIONS TAKE A MINIMUM 4-8 WEEKS FOR PROCESSING.

A FULL road closure refers to the blockage of all directions of traffic flow requiring detours.

A PARTIAL road closure refers to blockage of one or more lanes of traffic with traffic controllers directing traffic around the closure areas.

Fees are based on the length of the street closure or the length of the property street frontage, whichever is higher.

Fees for this application are asper Council's Fees & Charges.

Please note there is both an application fee and an occupation fee.

For further information or questions regarding this form, please contact Council via 9911 6555.

Applicant Details

First Name *

Surname *

Email: *

Contact Number *

Company Name *

Postal Address *

Postcode *

Suburb *

Type of Work

Are the works taking place on or near a State Road or traffic signals? *

YesNo

Please upload Road Occupancy Licence (ROL) *

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Are you submitting a partial or full road closure? *

PartialFull

Please upload a Traffic Management Plan *

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Please upload a Traffic Guidance Scheme *

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Width of area required (m) *

Length of area required (m) *

Street Address of site *

Suburb of site *

Postcode of site *

Start date *

End date *

Start time *

End time *

Days of the week *

Type of work: *

Development Application Details

Is there a current Development Application (DA) or Complying Development Certificate (CDC) lodged with Council for this property? *

YesNo

DA/CDC Number *

Approval from Police Traffic Branch

Please upload written approval from the Police Traffic Branch, Burwood *

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Insurance

Please upload your Public Liability Insurance *

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Council requires evidence of your current Public Liability Policy, identifying and naming the City of Canada Bay Council or ‘any local government where the activity is taking place’, with a cover of $20 million.

Applicant Declaration

I agree to the terms stated in the Road Closure Permit Terms & Conditions.
I confirm that all details given are correct.

Applicant Signature *

Draw signature|Type signatureClear

Date *

RDApproval - Closures

(For Internal Use Only)

RdClsApp