Fillable Corridor-Access-Request-Application Corridor access request

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Corridor-Access-Request-Application Corridor access request

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Country of origin: NEW-ZEALAND
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Private Bag 9023 | Whangarei 0148 | New Zealand
T: 09 430 4200 | 0800 WDC INFO | 0800 932 463 | F: 09 438 7632
W: www.wdc.govt.nz | E: mailroom@wdc.govt.nz
10/109423 October 2010
Corridor Access Request
Request No
I (Applicant’s name)
Address
As agent/principal
(owner)
Client ref/job no
Notify you: Road Corridor Coordinator, Simon Megchelse Ph: +64 9 09 470 3031 Mobile: 027 270 3820
Email: mailroom@wdc.govt.nz
Of our intention to undertake the following work
Type of work
Project
Minor
Emergency
Details of proposed work (indicate all aspects)
Utility company
Installing cabinet/pedestal or chamber/pole
Local Authority – Roading/Waste/Water
Installing structure or other (specify below)
State Highway Authority/Rail Authority
Trenchless construction/overhead
Developer
Consent no
Open trenching/pavement repairs (specify below)
Event organiser/body/management
Removing pole/cabinet/pedestal/structure
Member of public/other
Parade/sport event/community event/other
Description of work
Address
Location in road
Estimated start date
Duration/end date
* 24 month maintenance liability period starts once Council signs off a submitted works completion notice
Contractor details
Role to be undertaken
Utility operator
Major
Minor
Emergency
Company name
Contact person
Postal address
Work phone
Home phone
Mobile
Email
If the above information is not provided, the C.A.R will be deemed not to have been lodged.
Lodgement will be deemed when the required information has been submitted complete with applicable
plans/information.
We hereby agree for/or on behalf of the utility operator, to comply in full with the requirements of the code:
Utilities’ Access to the Transport Corridors, and any other reasonable conditions required by the Corridor Manager
and to keep this notice on site while work is in progress. This request is valid for six (6) months from date of issue.
Note: All work must comply with Health & Safety Act 1991 or any amendments to it.
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Date
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Corridor-Access-Request-Application Corridor access request

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Completed 15 May 2020

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