Application for gates/grids transfer of ownership

In accordance with Local Law No. 1 (Administration) 2011 and Subordinate Local Law No. 1 (Administration) 2021, I/we hereby apply for a transfer of ownership for a gate or grid permit including approval to undertake work on the road.

Applicant/Owner Details

Applicants Name *

Residential Address *

Suburb *

State *

Postcode *

Postal Address *

Suburb *

State *

Postcode *

Home Telephone Number *

Mobile Telephone Number *

Email Address *

Gate/Grid Details

Road on which gate/grid is installed *

Name of property *

Lot Number *

Plan Number *

Chainage at which gate/grid is installed (e.g. 20.8 kilometres) *

From specific feature (e.g. Lynd Highway) *

GPS Coordinates - Easting *

Northing *

Previous permit holders name *

Public Liability Insurance Declaration

Applicants must possess a public risk policy of insurance for an amount of at least $10,000,000 (10 million dollars) showing the Department of Natural Resources & Mines AND the Charters Towers Regional Council as interested parties.

Name of insurer *

Policy number *

Attach copy of insurance policy. *

Expiry Date *

Agreement

Agreement to urgent maintenance work

The landholder (permit holder) hereby agrees that, in the event of urgent maintenance work required on a grid to alleviate a hazardous situation, where the Council has become aware of the need, and where it has made a reasonable effort to contact them, but are unable to do so within 7 days, and/or for all that repair work not completed withinthe time stated on a Notice for Rectification, to pay Council for all costs incurred for the works carried out. Note that this does not relieve the landholder from their responsibility in relation to due diligence and public safety.

Agreement to remove the grid and make good

The landholder (permit holder) hereby agrees that, in the event of the of the permit being relinquished by the landholder, or cancelled by Council, the landholder (permit holder) shall be responsible for removing the grid an appurtenances from the road and reinstating the roadway in accordance iwth Council's policy. If the removal is not completed by the required time, or to the satisfaction of Council, and Council undertakes the work, the landholder (permit holder) agrees to pay Council for all costs incurred in removing the grid.

Declaration

I hereby certify that the details contained within this application are true and correct. Validation of the CAPTCHA below confirms my intention to request a transfer of ownership for the abovementioned gate/grid.

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Date * +