The personal information collected on this form under the authority of the Municipal Act, 2001 and is for the purpose of the
proper administration of Road Occupancy Permits. Specific questions relating to the Municipal Freedom of Information and
Protection of Privacy Act can be directed to Director of Public Works, County of Duffeirn, 519-941-2816 ext. 2600.
55 Zina St, 2
Floor, Orangeville, ON L9W 1E5
Phone: 519-941-2816 ext 2600 Fax: 519-941-4565
Road Occupancy and Access Application
Company Name Contact Name
Business Phone Email
Emergency/After Hours Contact Emergency Phone
Date of Application: _______________________________________________ OFFICE USE ONLY Deposit required: _______________
Commencement: _______________________________________________ OFFICE USE ONLY Service fee: _______________
Completion: _______________________________________________ OFFICE USE ONLY Total fee: _______________
Locations (Dufferin County roads only) and Details of Road Occupancy:
Type of Work and/or Purpose
New Installation
Road Closure
Pavement Cut
Augered Rd Crossing
Special Event
Entrance Installation
Other (explain)
The ap
plicant agrees and accepts full responsibility for the protection of all utilities, private property and persons affected
by his/her operations and further indemnify and save harmless Dufferin County and all assets and personnel it is in law
responsible for. The applicant further agrees to provide proof of insurance as provided for under Construction, Installations
and Repairs Conditions #1.
I/We the undersigned have read and understood the information provided and agree to abide by all Conditions as they may
apply to the approved Permit.
nts Signature: _____________________________________________ Date: ____________________________
Permit Number
Submit By Email
Print A Copy
click to sign
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General Conditions
1. INSURANCE Requirement: In order to receive a Dufferin County issued permit the applicant MUST PROVIDE proof of
a valid insurance certificate naming the County of Dufferin as additional insured with minimum Commercial Genera
iability (CGL), General Aggregate and/or Umbrella coverage of five million dollars ($5,000,000.00).
2. This permit is not valid until all copies are signed, approved and issued. Permits are valid for the date, time, locations and
ype of work listed only.
3. Normal Hours of Operation will be 7:00am to 7:00pm (summer) and 7:00am to 4:00pm (November 15 to March15).
Specific restrictions may be imposed.
4. The Applicant will ensure all personnel working under this permit do so in accordance with Ministry of Labour's
Occupational Health and Safety Act for Construction Projects. Trench safety will be in accordance with current Ministry
of Labour Standards.
5. When working, a copy of this Permit, all Utility Stakeouts and a Traffic Control and Protection Plan must be on site at all
6. The Applicant agrees and accepts full responsibility to supply, maintain, keep in clean condition and place all barricades,
warning signs, delineators and flashing lights, necessary for the protection of the public and the safe operation of the
installation, at the applicant's own expense, as per the Ontario Traffic Control Manual, Book 7, Temporary Conditions
latest revision.
7. All utilities shall be protected and supported, to the satisfaction of the utility concerned.
8. Roads shall Not Be Closed unless expressly stated and approved by the County.
9. Open cutting of the Road is Not Permitted unless prior approval is obtained.
10. The road surface, sidewalks/walkways and boulevards shall be kept clear of obstructions or debris to avoid hazard o
nconvenience to the public.
11. Mud tracking or dust nuisance shall not be allowed. Any accumulation must be cleaned from the road and/or shoulders
immediately. If at any point County supervisory staff find that mud tracking or dust nuisance is excessive, the work shall
be stopped.
12. The Applicant shall not cut, trim or interfere with any trees in the right-of-way without County approval.
13. Property owners and /or residents shall receive a minimum of 24 hours written notice prior to temporary closing of an
access to homes and businesses.
14. Positive drainage shall be maintained during the course of the work.
15. All trenches shall be fully compacted by mechanical means, (roadway 100% S.P.D., roadside 95% S.P.D.) Mechanical
and/or vibratory compaction equipment shall be on site prior to commencing work.
16. Small excavations or pits in the boulevard will be covered with a minimum of 20mm plywood, secured and surrounded
by a minimum of 1.2 metre high snow fence I construction fencing to prevent access. The excavated material may be
stockpiled on the boulevard, provided there is sufficient room and the material does not encroach on either the traveled
portion of the road or public entrances.
17. Crash attenuation devices will not be removed, dismantled, or in any way altered so as to affect the normal operation of
the equipment. Where a crash attenuation device conflicts with the conditions of this permit, the Applicant must contact
the County office for review.
18. On hot-mix asphalt pavement, cutting shall be done by means of sawing full depth to leave a clean straight edge.
Excavation equipment such as backhoes, etc., shall not be used for this purpose. The adjoining pavement shall be
protected from damage by equipment. A step-joint will be created prior to final paving.
19. The Applicant accepts the County's right to perform any necessary remedial work caused by the Applicant's operation
subject to the following conditions:
(a) At least 24 hours prior, verbal notification will be given to the Applicant of any required remedial work. When
this time elapses, the County will undertake the repairs.
(b) When it is deemed to be a matter of PUBLIC SAFETY or an EMERGENCY, the County will perform immediate
(c) The Applicant agrees to reimburse the County of Dufferin for all costs incurred under 18a and/of 18b and/or t
supply to the County a Security Deposit, for a specified amount, where applicable