Permit for Works Within Road Reserve

Please note: this form requires a fee of $120. This fee can be paid by credit card over the phone after the application has been submitted. Additional fees may apply in particular circumstances. Cash and cheque payments can be made in person by visiting the Borough of Queenscliffe, 50 Learmonth Street, Queenscliff.

For full conditions, please see the list at the bottom of this application.

Location and owner details
Applicant/contractor details

If contractor is not registered with Council, provide the following information:

Purpose of works
Quantity of works

Fill in the quantities of works to be undertaken by surface type, where applicable:

Road pavement
Vehicle crossing
Kerb & channel
Nature strip
Conditions and affirmation

The permit will be granted subject to the following conditions.

  1. These conditions apply to any opening proposed in a road for gaining access to, or the installation of, reticulated water, gas stormwater, electrical, sewerage or telecommunications services, or any other works, that may cause damage to Council assets located in a road.
  2. Road openings are subject to the requirement of Council's Local Law No. 2, 2010. Penalites apply and or reinstatement costs will be charged to any person who does not comply with these requirements.
  3. Work must only be performed by a qualified Tradesportson or authorised person who has a current Public Liability Insurance Policy for a minimum amount prescrived by Council. Documentary proof of such insturance is required when obtaining a permit.
  4. A permit must be obtained by such qualified Tradesperson or authorised person prior to work commencing.
  5. Permits must be available at the works site for inspection by any Council Officer or a member of the Victorian Police Force.
  6. It is the permit holder's responsibility;
    1. to liaise with other Authorities to ensure damage does not occur to existing services and assets.
    2. to provide for hte safety of pedestrians and vehicular traffic. Signage must conform to Australian Standards AS 1742. Where traffic is restricted to one lane, a flagperson must be provided; and
    3. to adequately light, sign and barricade openings if left overnight.
  7. Inconvenience to the public shall be kept to minimum, and the permit holder will be responsible for the safety of traffic. If it is deemed that traffic is restricted and/or public safety is being threatened, Council will then undertake emergency work to overcome any hazardous conditions and charge the permit holder for all relevant cost.
  8. All conduits or services placed shall have a minimum cover of 750mm, unless otherwise specified by Council's Works Inspector.
  9. Constructed roadways with sealed surfaces shall be bored where possible. Where trenching is required, backfill shall be as follows.
    • Footpaths - Class 3: 20mm FCR to surface level
    • Nature Strips: Excavated material topped with sodded grass or 50mm of topsoil with lawn see
    • Roadways, Parking Areas or Hard Standing Areas - Class 2: 20mm FCR to surface level
    Compaction must be sufficient to ensure that no subsidence occurs - ie. use material at suitable moisture content, then place and compact in 150mm layers using a suitable roller or vibrating plate.
  10. Bituminous and concrete surface reinstatement will be performed by Council, the cost of which is included in the permit fee. Removal of all excess spoils is the responsibility of the permit holder.
  11. A permit shall not be valid until the prescribed fee has been paid.
  12. Permits shall only be valid for a period of 12 months from date of issue. After that time, a new application must be submitted and approval is then based on the regulations applying at that time.
  13. Current road opening charges and fees, and the required minimum Public Liability Insurance cover, are displayed at the Council Offices, where permits may be obtained. General enquiries may be directed to the Borough Engineer on (03) 5258 1377.
  14. The standard application fee as of 01 July 2020 is $120 and must be paid prior to the permit being granted. By submitting an application, you agree to pay on demand a further fee as may be assessed in these rates if the disturbed areas exceed those stated.
  • In selecting the box below, you agree to the above conditions, and affirm that all details supplied in this application are true and correct to the best of my knowledge.