Application for Road Opening Licence.pdf - Roscommon County ...
Application for Road Opening Licence.pdf - Roscommon County ...
Application for Road Opening Licence.pdf - Roscommon County ...
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ROSCOMMON COUNTY COUNCIL<br />
<strong>Application</strong> <strong>for</strong> <strong>Licence</strong> to open road and/or to connect to a water supply or sewerage services<br />
PART 1<br />
DETAILS OF APPLICATION<br />
1. Name of Applicant: ___________________________________ Phone No: _____________________<br />
2. Current Postal Address of Applicant: ____________________________________________________<br />
3. Purpose <strong>for</strong> which licence is required: (Tick in appropriate box)<br />
a) Connection to Group Water Scheme €600 per connection<br />
b) <strong>Road</strong> <strong>Opening</strong> <strong>Licence</strong> <strong>for</strong> connection to Water<br />
Supply/Sewerage (This refers to Planning<br />
Permission applied <strong>for</strong> on/after 10 th March 2004)<br />
€600 per road opening<br />
(N.B. Proof of Payment of development levy must be submitted with this application)<br />
State purpose: ___________________________________________________________________<br />
4. Location of connection/opening (Townland or Street): ___________________________________<br />
(N.B. Site map must be submitted showing exact location of development and proposed connection.)<br />
5. Diameter of connection pipe: _______________________________________________________<br />
6. Description of premises to which connection is to be made: _______________________________<br />
7. If more than one dwelling is involved, state number of dwellings: __________________________<br />
(In the case of connections to housing estates or apartment blocks, the licence fee must cover the total<br />
number of proposed dwellings <strong>for</strong> which planning permission/approval was granted).<br />
8. State whether premises is new or existing: _____________________________________________<br />
9. If Planning Permission was granted within the past five years, state:<br />
(a) Date Granted ______________________ (b) Planning Ref. No. ____________________<br />
10. Name and Address of Contractor who will open the road _________________________________<br />
____________________________________________________________________ Phone No: ___________________<br />
11. Applicants are responsible <strong>for</strong> materials and employment of Contractor to make the connection.<br />
12. Contractors must satisfy <strong>Roscommon</strong> <strong>County</strong> Council insurance requirements.<br />
13. Advance notification of connection must be given to <strong>Roscommon</strong> <strong>County</strong> Council.<br />
14. The relevant <strong>County</strong> Council Waterworks Caretaker/Sewerage Caretaker must supervise the connection<br />
Declaration of Contractor<br />
I confirm that I have been retained by the above named applicant to carry out the road opening <strong>for</strong><br />
the work proposed. (Note: It will be necessary to furnish proof of public liability of €6.348m to<br />
<strong>Roscommon</strong> <strong>County</strong> Council be<strong>for</strong>e the licence can be issued)
Signed: ________________________________________<br />
Date: ____________________<br />
Please note Contractor must stamp <strong>for</strong>m as well as sign it.<br />
PART 2<br />
Contractor’s Stamp:<br />
UNDERTAKING AND PAYMENT OF FEES<br />
15. I agree to carry out the works in accordance with <strong>Roscommon</strong> <strong>County</strong> Council’s requirements, which are<br />
set out in the Standard Conditions.<br />
16. I agree to pay appropriate water charges, which may be levied from time to time by <strong>Roscommon</strong> <strong>County</strong><br />
Council.<br />
17. In consideration of <strong>Roscommon</strong> <strong>County</strong> Council granting me a <strong>Licence</strong> <strong>for</strong> the purpose as set out at 3<br />
above, I enclose herewith the sum of €_______________ being the appropriate licence fee. (see 3 above)<br />
Signed: _________________________________<br />
Date: ____________________<br />
PART 3 – FOR OFFICAL USE ONLY<br />
FINANCE SECTION:<br />
<strong>Road</strong> <strong>Opening</strong> <strong>Licence</strong> Fee of €_______ received<br />
and Official Receipt No. ___________ issued.<br />
Initials: _____________ Date: ____________<br />
WATER SERVICES SECTION:<br />
Certificate of Insurance checked.<br />
Yes & in Order<br />
Initials: __________ Date: _________<br />
RECOMMENDATION OF ENGINEER<br />
Decision - Grant/Refuse<br />
Recommendation on <strong>Application</strong> - Grant/Refuse<br />
Signed: ________________________________<br />
Senior Executive Engineer<br />
Date: ___________________<br />
Signed: _________________________<br />
Senior Engineer<br />
Date: ___________________