Rangitikei District Council

(*) Denotes that these fields are required to be be filled in before the application can be submitted.


Definitions:


ROAD CLOSURE REQUEST - Any work that is to be carried out in the road reserve which entails the road to be closed.


ROAD OPENING REQUEST - Excavations in the road, footpath, berm/verge or road reserve including all network utility operators.


VEHICLE CROSSINGS URBAN & RURAL - New entranceways or alterations. $200 inspection fee.


EVENT REQUESTS - Parades, fun runs, market days and/or any sporting events that utilises any part of the road or footpath which may entail the closing of the entire road.

Please tick appropriate box (*)
Road Closure Request
Road Opening Request
Vehicle Crossings Urban & Rural
Event Request

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To the Roading Department:
I/we wish to carry out the work described in the plans and specifications herewith and/or as described below.


Contact Details:

(a) Principal Full Name (*)

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(a) Principal Phone Number (*)

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(a) Principal Email Address

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If Event Request is chosen please indicate the name of the event

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(b) Contractor Full Name (*)

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(b) Contractor Phone Number (*)

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Work Type: (*)
Service Connection (separate connection application is required - Stormwater, Water and Wastewater)
Major
Minor
Emergency

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Details of Work or Event: (*)

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Street Name and Number: (*)

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Town: (*)

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Estimated Start Date: (*)

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Estimated Finish Date (*)

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Location in Street: (*)
Berm/Verge
Footpath
Roadway

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Site Plan (if yes please attach - see below)
Yes
No

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Please attach site plan

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Traffic Management Plan (if yes please attach - see below)
Yes
No

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Please attach Traffic Management Plan

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Surface Reinstatement carried out by: (*)

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The Principal, Network Utility Operator or Contractor remains responsible for rectifying any defects in the trench reinstatement for a period of 12 months after the surfacing is completed.Note: This notification refers to all work within legal road reserve.

I have read and fully understand the implications of the preceeding paragraph (*)
Yes
No

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Full Name

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Date (*)

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