2012 087933 Application Form Road Opening Permit - Ku-ring-gai ...

einstatement works the Contractor is required to undertake pursuant to this Permit are temporary works
necessary to keep the road safe until final restoration works are completed by Council. I further agree to pay
any additional restoration charges which may be incurred by Council, as a result of the costs to restore the
road to the condition it was in prior to the works being undertaken being greater than estimated.
I accept full responsibility for the public safety and for injury to any person or persons and damage to any
property, which may occur during the period of the works, or as a consequence of the Works the subject of
this Permit. I agree to notify Council’s Restorations Supervisor on Telephone Number 9424 0194 on the
completion of the work so that the final reinstatement works can be carried out by Council.
SIGNATURE OF APPLICANT ……………………………… Date……………………….
Subject to payment and Approval the person named over is hereby permitted to undertake the
Proposed Works, in strict accordance with conditions attached to this application.
TYPE
AREA
RATE
Receipt Code $ c
PERMIT FEE ITEM ------ ------ 608
ROAD OPENING
Concrete Reg 624
Loc 618
Asphalt Reg 625
Loc 619
ROAD SHOULDER Gravel Reg 626
Loc 617
Driveway 630
FOOTPATH OPENING Concrete 629
Asphalt 631
Pavers
NATURE STRIP/GRASSED Grass/Earth 633
VERGE
KERB & GUTTER
Concrete Reg 621
Loc 620
Kerb Hole Reg 637
Loc 636
TOTAL
Date Paid ……………………………..
Receipt No ….………………………..
2012/087933