Application for Temporary Road Closure

Add: 48 Longueville Rd, Lane Cove Post: PO Box 20 Lane Cove 1595
Tel: (02) 9911 3555 Fax: (02) 9911 3600 Web: lanecove.nsw.gov.au Eml: service@lanecove.nsw.gov.au

Please allow at least seven (7) days to process this application. If the application requires
representation to the Local Traffic Committee and Council please allow six (6) weeks for approval.

Fees Non Refundable Application Fee $440.00 (Per Day)

(Cashier Code: T361)
Fees are valid until 30 June 2020

(For payments by credit card a 1% merchant fee is applicable). If submitting

electronically a Credit Card Authorisation form is required.
Applicant
Company Name: …………………………………..... Name: ....................................................

Address: ……………………………………………………………………………………………….

Suburb: ………………………………………….. Postcode: ………………………

Telephone No: (BH) …………………………………….. (AH) …………………………………..

Mobile: ………………………………………………….. Fax: …………………………………….

Email: ……………………………………………………………………………………………......

Road Closure
Street: ………………………………………………………………..
Details
Between Streets: ………………………………………. And …………………………………..…

Suburb: …………………………………………………….

Plant Type (if applicable): …………………………………………….

(If a plant is needed, please also refer to the Application Form for Standing Plant
Permit. Additional fee applies.)

Other Specific Information: ………………………………………………………………………….

Reason/ Purpose: …………………………………………………………………………………….

Requested Date/s: ……………….……… to …………….………………

Requested Time/s: ………………………. to …………………………….

No of Vehicles: Cars: ……………… Trucks: …………………..

Traffic Management
Please circle the event catetgory:
Details
Category 1 – Local Road

Category 2 – Major Local Road

Category 3 – Collector

Will a 3m wide traffic lane remain open for traffic at all times? Yes/ No

Does the site area encroach or interfere with the following:

29738/13 Rev 7/19 SU 1462
 Yes No
Footpath
Parking Lane
Traffic Lane

Will alternative arrangements be provided for the following:

Yes No
Pedestrians
Motorists
Property Access
Bus Access
Emergency Vehicle Access
Loading Zones

If so, what provisions are proposed? ………………………………………………………………

…………………………………………………………………………………………………………

Traffic Control Plan

Will RTA accredited traffic controllers be used to implement the Traffic Control Plan? Yes/ No

Has the NSW Police Service, Traffic Branch, Chatswood (Ph 9414 8515) been advised of the
proposed closure? Yes/ No

Name of Officer: ………………………………………..

The Traffic Control Plan must be in accordance with AS 1742.3 – 2009 illustrating site area
and position of plant, all signage and traffic control devices that are to be used.
Attached? Yes/ No

I certify that our Traffic Control Plan complies with AS 1742.3 – 2009 and all workcover
requirements. In addition, I will ensure that the site is controlled as described in the attached
Traffic Control Plan.

Signed: …………………………………………. Date: ………………………….

Conditions of
1. A copy of the company’s Public Liability Insurance ($10 million) must be submitted
Consent
with the application.
2. Standard hours for road closures are: Mon- Fri 7am to 5pm & Sat 7am to 1pm.
3. Any variation to these hours must have written consent by the Manager Traffic. The
applicant must provide a safe pedestrian/ cycle route around the work area.
4. The Site must be kept clear of all tripping hazards, with the route clearly visible and
delineated.
5. All affected businesses, residents and other occupants must be notified in writing
prior to the works commencing.
6. All associated fees and charges are in accordance with Lane Cove Council’s
Schedule of Fees & Charges.
7. The Permit fee must be paid at the time of lodgement. Any additional fees and
charges will be invoiced to the company at a later date.
8. The Urban Services Division of Council reserves the right to cancel the permit at any
time should any of the conditions not be complied with.

Privacy Under the Privacy or Personal Information Protection Act (PPIPA), Council is required to
advise you that personal information being collected from you in relation to this matter will
only be used for the lawful and proper functions of Council. Any such use will be in
accordance with this Act and its associated Management Plan and Codes.

29738/13 Rev 7/19 SU 1462