The Rural Municipality of Archie

Local Government

Local Government - Spring Road Restrictions - Permit Application

 

APPLICATION FOR CONSENT TO USE A ROAD

 

Full Name of Applicant: _______________________________________________________________

(if a company provide company name)

 

Postal Address _______________________________________________________________________

 

Phone/Cell  Numbers___________________________Email Address ____________________________

 

Date of Travel:  IN _______/_________/_______    OUT  _______/_________/_______

 

Details / Name of  of road(s) you wish to use: _____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

 

Vehicle(s) Details: _____________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

 

Weight: _________________________________  No. of Axels __________________________________

 

Purpose of Use: _______________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

 

If consent is granted, it will be subject to the conditions set out under Schedule A of this consent and by signing this form you agree to be bound by and comply with the conditions set out in Schedule A of said consent.

 

 

 

Signature of Applicant: ___________________________________  Date  _______/_________/_______

 

 

 

SCHEDULE “A” TO APPLICATION FOR CONSENT TO ROAD USE

 

  1. The consent may be revoked by:

a.       If weather conditions vary from the date on which the Consent is granted

b.      If the Road(s) specified in the Consent instrument suffers any damage prior to or as a result of the use of the Road pursuant to the Consent; or

c.       At any time at the discretion of the Rural Municipality of Ellice - Archie

 

  1. The Consent is for the specified Road(s) and the duration, purpose and vehicle(s) stated in the Consent instrument

 

  1. The original Consent application and approval letter must be carried in the vehicle or primary vehicle if there are more than one at all times and shall be presented to any authority that requests such documents.

 

  1. The Grantee must not cause any nuisance, damage, disturbance, danger, risk or hazard to the occupiers of land adjacent the specified Road(s).

 

  1. The Grantee must not carry out any civil works or improvements on or around the specified Road(s) without consent from the Rural Municipality of Ellice - Archie.

 

  1. The Grantee accesses and uses the specified Road(s) at its own risk and the Grantee bears the risk and costs of and must compensate the Rural Municipality of Ellice - Archie for any loss or damage to the specified Road(s) and land adjacent to the specified Road(s) .

 

  1. The Grantee must ensure that the vehicle(s) to be driven on the specified Road(s) are insured.

 

 

The Grantee must ensure that its agents, contractors and employees comply with the Consent and Schedule A of same.