Application for installation
of vehicle crossing
Please read this first
This form will be scanned by electronic equipment. It is important that you:
use a blue or black pen to complete this form; and
print clearly.
If you have any queries regarding this form, please contact Tararua Alliance, 06 374 5341.
tararua district council
26 gordon street
po box 115
dannevirke 4942
06 374 4080
Building/Resource consent numbers
Building consent number Resource consent number
Contractor details (Please print in CAPITALS)
Contractor name
Postal address
Town Postcode
Business phone number Mobile phone number
Details of property where work is to be undertaken (Please print in CAPS)
Street/Rapid number Street/Road name
Rate assessment number Valuation number Parcel number
Lot number Section number DP number
Office use only
Application fee: vehicle crossing
Bond: vehicle crossing
Council receipt codes for vehicle crossing fees
District-wide W149.37
Bond 9999.0913.6690
Receipt No.
/ / 2 0
Authority register number
Application approved by
page 2 of 3 | application for installation of vehicle crossing | version: 3 | issued: 24 july 2020
Property owner details
Name of owner
Contact phone number Mobile phone number
Description of development
E.g. three townhouses on cross lease title, block of shops, warehouse, etc
Details of vehicle crossing
Type required:
Single Double
Number required:
Installation date (please allow 15 working days for processing of application)
/ /
2 0
As-built plan
On the plan below, please provide a drawing of the proposed works, including the location of the installation; or
See attached plan
Subject property
application for installation of vehicle crossing | version: 3 | issued: 24 july 2020 | page 3 of 3
Statement / terms and conditions
Contractors working on/connecting to Council assets agree to:
obtain all relevant approvals prior to carrying out works (corridor access request and trafc management plan);
complete the work to standards outlined in nzs 4404 and Council’s District Plan;
provide a notication of completed works, and associated satisfactory as-builts;
contact Council’s contractor (Tararua Alliance) if any changes/amendments are made to approved plans.
I also understand that:
I am responsible for all costs associated with physical works, legal costs and reinstatements once I have gained ofcial
lodgement does not guarantee approval of installation;
only accredited contractors are permitted to work on Council assets;
approval will be issued within 15 working days of Council receiving this completed form;
a bond is required to be paid at the time of application, and that the refund will be processed once nal inspection has
been completed;
the application fee is additional to the refundable deposit.
/ /
2 0
Signature of applicant Date
Print name
Checklist – have you included?
Contact details Corridor access request Completed application form
Relevant as-built plans Trafc management plan
click to sign
click to edit