Get Road Occupancy Licence Application Form N

FORM N Road Occupancy Licence Application Non-Development Special Event Activities Is this an extension of existing / previous licence No Yes - Licence. original attached Was this application entered on-line Yes - Application. on-line print out attached CONTACTS Proponent Organisation Your Reference No* Contact Name On-site Company Phone Contact Name Fax On-site Phone TIMES LOCATION Email Subject Road UBD From Cross Street To Suburb Council Requested Start End Dates Estimated Duration of Activities Enter start date of 1st shift start date of last shift Duration for this application ONLY in number of hours/shifts Times For example Mon - Fri 1000 - 1500 Sat 0700 - 1300 Project Current Speed Limit PROPOSED ACTIVITIES Work Description for this Km/h Lane/s or Shoulder/s Closed Direction Flow Management Hoardings Hazard Reduction Utility Maintenance SRA Works Investigation Landscaping / mowing Police Operations Crane Special Event Licence Type Abnormal Load Movement Bridge Building Construction Building Work Zone Other Site access Median Shoulder Lane 1 kerb Lane/s Lane 2 next after kerb lane Lane 3 Lane 4 All directions East bound West bound East and West bound North bound South bound North and South bound Standard lane merge Contra Flow Stop / Slow Control Detour other roads Detour side-track Portable Signals Mobile works Short term / Intermittent works Non-Trafficable Area Turning Bay/s affected SIGN RMS Miscellaneous Yes Total no. of lanes to be closed at any one time in same direction lane s of Speed reduction Community Notification km/h Apply for SZA Newspaper Letterbox drop VMS If this project is managed by the RMS fill in the following RMS Branch I hereby apply for a Road Occupancy Licence Please allow a minmum of 10 working days to process this application* Signature Fax to the RMS office relevant to the location of the application* TMC-SOP-502016 - F2 Refer to Explanatory Notes for fax numbers. original attached Was this application entered on-line Yes - Application. on-line print out attached CONTACTS Proponent Organisation Your Reference No* Contact Name On-site Company Phone Contact Name Fax On-site Phone TIMES LOCATION Email Subject Road UBD From Cross Street To Suburb Council Requested Start End Dates Estimated Duration of Activities Enter start date of 1st shift start date of last shift Duration for this application ONLY in number of hours/shifts Times For example Mon - Fri 1000 - 1500 Sat 0700 - 1300 Project Current Speed Limit PROPOSED ACTIVITIES Work Description for this Km/h Lane/s or Shoulder/s Closed Direction Flow Management Hoardings Hazard Reduction Utility Maintenance SRA Works Investigation Landscaping / mowing Police Operations Crane Special Event Licence Type Abnormal Load Movement Bridge Building Construction Building Work Zone Other Site access Median Shoulder Lane 1 kerb Lane/s Lane 2 next after kerb lane Lane 3 Lane 4 All directions East bound West bound East and West bound North bound South bound North and South bound Standard lane merge Contra Flow Stop / Slow Control Detour other roads Detour side-track Portable Signals Mobile works Short term / Intermittent works Non-Trafficable Area Turning Bay/s affected SIGN RMS Miscellaneous Yes Total no. of lanes to be closed at any one time in same direction lane s of Speed reduction Community Notification km/h Apply for SZA Newspaper Letterbox drop VMS If this project is managed by the RMS fill in the following RMS Branch I hereby apply for a Road Occupancy Licence Please allow a minmum of 10 working days to process this application* Signature Fax to the RMS office relevant to the location of the application* TMC-SOP-502016 - F2 Refer to Explanatory Notes for fax numbers.