Application for Temporary Road Closure

Required fields are marked with an asterisk (*).

Application Temporary Road Closure Form

Contact Details

Firstname

Surname

Mobile Enter your mobile number without spaces

Home phone Enter your mobile number without spaces

Work phone Enter your mobile number without spaces

Address line 1

Address line 2

Postcode Enter your postcode without spaces

Suburb

Application for Temporary Road Closure

Date of Proposed Road Closure *

Day Month Year

Start Time *

Hour Minute Second

End Time *

Hour Minute Second

Name of Event / Purpose of Road Closure *

Name of Road/s to be closed *

Pedestrians will be involved *

Motor Vehicles will be involved *

Arrange Accredited Person (ie CFS/Council Staff) to erect signage. *

Name of person/s erecting signage

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