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Roads Opening and Access Application

About this Form

ABOUT THIS FORM

Use this form to apply for approval to Bore/excavate under roads or footpaths.

Note: If the proposed works are on a classified road then concurrence of the Roads and Maritime Services will be required.

PRIVACY

Port Stephens Council is committed to protecting your privacy. We take reasonable steps to comply with relevant legislation and Council policy.

Purpose: Council collects the information to ensure owner's consent is given and that the proposed works are appropriate and fit for purpose.

Intended recipients: Council assessing Officers and its approved contractors will use the provided information to assess the proposed works.

Supply: This is legally required information for this application.

Consequence of Non Provision: The Application may not be assessed.

Storage and security: This document will be placed on the relevant file and/or saved in Council’s records management system in accordance with Council policy and relevant legislation.

Access: Please contact Council on 02 4988 0255 to enquire how you can access information.

Applicant Details

APPLICANT DETAILS

Are you applying as an individual or Company?: *

Individual
Company

Title: *

First Name: *

Middle Name(s): *

Surname: *

Home Phone: *

Mobile Number: *

Contact name: *

Company / Organisation Name: *

ABN: *

Office Number: *

Fax: *

Email Address: *

APPLICANT'S PHYSICAL ADDRESS

Physical Address: *

Physical Address Line 2: *

Physical Address Line 3: *

Suburb: *

State: *

Postcode: *

Is the postal address different to the physical address?: *

APPLICANT'S POSTAL ADDRESS

Postal Address: *

Postal Address (Line 2): *

Postal Address (Line 3): *

Suburb: *

State: *

Postcode: *

DISCLAIMER

I hereby make application to Council for permission to undertake the works as per this application and the plans submitted. I understand that if the information submitted is incomplete, the application may be delayed, rejected or more information may be requested. I agree to undertake the works in conformity with such approval and Acts and Codes, INDEMNIFY the Council of Port Stephens against all claims which may arise whether from negligence or otherwise as a result of my carrying out or instructing a third party to carry out work within the road reservation at the aforementioned address.

I confirm that I have read and agree to the above: *

Date: *

Date:

Name:

User type:

Road Opening / Access Details

ROAD OPENING / ACCESS DETAILS

Location: * Property the Road adjoins

Parcel ID: *

Proposed Start Date: *

Proposed End Date: *

Type of service: *

Brief description of works: *

Proposed method of Notification of Works to Adjoining Property Owners: *