Application for Activities in a Council Road Reserve

Application for Activities in a Council Road Reserve

(Under S138 of the Roads Act 1993 and Traffic & Transport Management for Special Events)
Use this form to apply for approval for:

A. Minor Works not involving a development application such as:
- Undertaking maintenance or investigation work utilising the road reserve or footpath.
- Doing minor works such as building a driveway or boring under a road.
- Undertaking minor road works involving minimal traffic impact.
B. Major Works when required by a condition of development consent.

C. Events undertaken in a Council Road Reserve or likely to impact traffic movements on a public road.
Is this an:*

Initial ApplicationAdditional Submission
Is this application associated with a DA or CDC?*

YesNo
If yes please provide reference number.

Applicant's Details
Company Name*
Contact Name*

First NameLast Name
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
ABN*

Details of organisation undertaking proposed works/event
Same as applicant details above*

YesNo
Company Name
Contact Name

First NameLast Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
ABN
Site Supervisor*
Site Supervisor Contact Number*
Please enter a valid phone number.
Activity Description *
for multiple activities please submit associated TMP's and TGS's for each, as required
Activity Proposed Start Date*

DayMonthYear
Date
Activity Proposed Finished Date*

DayMonthYear
Date
Activity Location*
if multiple activities please submit associated TMP's and TGS's for each, as required
Traffic Impacts - select traffic impacts identified by TMP*

no road closurepart road closurefull road closurepedestrian impactsno pedestrian impactsno traffic delaystraffic delays
If traffic delays, maximum expected time of delays
(minutes)
Traffic Controls - select traffic controls identified by TMP and shown in TGS*

signs only (no speed reduction)signs only (with speed reduction)stop/slow control (manual or automated boom gates etc)traffic lightsVMS
Other

Information to determine if a referral for other parties for approvals or concurrence
Location - will the proposed works/event be on crown or community land*

YesNo
Roads - Will the proposed works/event be on or may impact traffic movement on a classified road*

YesNo
Environmental - Will the proposed works/event impact any identified endangered fauna or flora*

YesNo
Environmental - Will the proposed works/event require the removal or lopping of any tree(s)*

YesNo
Cultural & Heritage - Is the proposed works/event near any identified cultural and/or heritage site*

YesNo
A sketch plan detailing all proposed works shall be submitted with each initial application.

An approval will not be issued without all information be supplied and appropriate fees being paid and any referral(s) received.

Any approval issued will only be for the work/event and location(s) listed above.

An approval will not be issued for a period that is past the date noted on the provided certificate of currency for public liability insurance.

An approval for works/events that have been identified for refereral will not be issued until such referral(s) is returned to Council and reviewed by Council. Please allow extra time for such referrals.

An invoice will be issued on information supplied. Council require a minimum of 10 working days to process this application from receipt of payment.
Traffic Management Plan (TMP)

Cancelof
Traffic Guidance Scheme (TGS)*

Please note if you do not provide a TGS your application will not be processed.
Cancelof
Contractor Public Liability Insurance *

Minimum $20M
Cancelof
Other Supporting Documents (ie Site Plan - showing locations and dimensions of the access crossing)

Cancelof
Applicant Signature*

Clear

Payment

Application for Activities in a Council Road Reserve

$228.00AUD Quantity

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Application for Activities in a Council Road Reserve

Other