R / 2015 /
ROADWORKS APPLICATION
For Approval Under the Roads Act 1993 and Local Government Act 1993
This application must be used to apply for a Levels Certificate and/or a Roadworks Permit:
to undertake construction work in the public road reserve in relations to a development approval condition
requiring you to submit engineering design plans for Council’s approval prior to the issue of a Permit.
for Council to provide a quotation to construct vehicle crossings or other associated roadworks (vehicle
crossings, footpath, kerb & gutter).
This form must not be used to apply for a Road Opening Permit. A Road Opening Permit is required when you
are excavating to lay service utility pipes in the road and footpath, including private stormwater pipes
discharging to the kerb and gutter. A separate form is available for this Permit.
How to complete this form
The applicant must read Part 1 Application Checklist and ensure that all required documentation is submitted
with the application. Failure to do so may delay the assessment of the application.
All fields on this form requesting information from the applicant are mandatory and must be correctly completed
before submitting the application.
NOTE: Payment is required at the time of submitting your application
Part 1: Application Checklist – to be read when filling out this Application
General Information: In accordance with Sections 138 & 139 of the Road Acts 1993 it is an offence
for any persons/organisations to carry out works on the footway/roadway without Council approval.
Council has the right to forward all expenses associated with the repair or replacement of any such
works, through a Sundry Debtors Account in accordance with Section 101 of the Roads Act 1993.
Related Development – supporting documentation: The roadworks application must be
supported by the following documentation, depending on the related development:
Development Application or Consent - A copy of the proposed/approved plan.
Complying Development Certificate - A copy of the related application and supporting
documentation provided by the Certifying Authority, including a full set of architectural plans and
a Stormwater Drainage Concept Plan which meets the requirements of Council’s DCP 2013.
Exempt Development – A plan of the proposed works. If the application is for a new vehicle
crossing, a plan of the associated off street parking space must be provided, demonstrating
compliance with AS/NZS2890.1-2004 Parking Facilities Part 1: Off- street car parking and
showing all existing buildings or structures on the property, any proposed retaining walls or
trees in close proximity to the parking space.
Engineering Plans Assessment: If this application relates to a development consent which includes a
condition requiring the lodgement of an engineering design for works in the public road reserve, the
application will only be considered when supported by those plans. Additional fees are applicable for plan
assessment.
When Council requires amended plans, additional assessment fees will be charged (min 2 hours).
Assessment of the application will not be resumed until the amended plans have been received and fees paid.
Level Certificate: A Levels Certificate is sometimes required as a condition of development consent when
you are undertaking new works in the vicinity of the property’s street frontage(s). The Levels Certificate
specifies the finished levels of the footpath or vehicle crossing adjacent to the property boundary.
Roadwork’s Permit: A Roadworks Permit is an approval issued by Council in accordance with Sections 138
& 139 of the Road Acts 1993. You will require a Roadworks Permit for works such as construction of a new
vehicle crossing, kerb & gutter, footpath, stormwater drainage (other than private stormwater pipes to the kerb
& gutter) or traffic control devices. The Roadworks Permit will set out the conditions under which the works
are to be undertaken, including approval of the design and extent of works
Security Deposits / Bonds: Your Development Consent may include a condition requiring payment of a security
deposit. However, when the works are to be undertaken by a private contractor, a security deposit will still be
payable prior to commencement of works, even if not required by the Consent. Council reserves the right to
withhold the security deposit and undertake the works, repairs or replacement of the works, at the applicant’s
expense, if they are not undertaken to its satisfaction. Requests for refund of the deposits will only be
considered following a request in writing.
PO Box 45, Leichhardt NSW 2040 | Ph: (02) 9367 9222 | Fax: (02) 9367 9111 | Email: leichhardt@lmc.nsw.gov.au
Road Works Application Form | Updated: June 2015 | Page 1 of 3
Part 2: Applicant’s Details
Salutation: Mr / Mrs / Ms / Miss Other: ___________________________________
(please circle) (please specify)
Given Name: Surname:
Business/Company Name:
Street Address:
Suburb: Postcode:
Phone No (Bus Hours): Mobile No:
Fax No:
Email Address:
Part 3: Address of Works
Street Address:
Suburb: Postcode:
Part 4: Related Development (please tick and provide Application/Certificate No)
Development Application
Complying Development pursuant to SEPP (Exempt and Complying Development Code) 2008
Exempt Development pursuant to SEPP (Exempt and Complying Development Code) 2008
Related Application / Certificate No: _____________________________________________________
Supporting documentation is attached (refer to Part 1)
Part 5: Application (please tick) Fee
Levels Certificate and/or Roadworks Permit $175.50
Estimated _____________ @ $_____________
Engineering Plans for assessment hours $133 per hour (min $266)
(min 2 hours)
Part 6: Your Declaration
I, ______________________________________________________________ (Print Name) have read and understand
the above requirements and agree to satisfy them prior, during, and upon completion of any work in the footway
and or roadway area.
I understand that information provided with this application (including the application form) and any subsequent
information submitted as part of this application, may be disclosed under the provisions of the Government
Information (Public Access) Act 2009 and correspondence from Council may be made available for viewing by
the general public.
Applicant's signature: Date:
_____ / _____ / _________
PO Box 45, Leichhardt NSW 2040 | Ph: (02) 9367 9222 | Fax: (02) 9367 9111 | Email: leichhardt@lmc.nsw.gov.au
Road Works Application Form | Updated: June 2015 | Page 2 of 3
Privacy Statement
Application forms and/or names and addresses of people making an application is information that is publicly
available. In accordance with section 18(1)(b) of the Privacy and Personal Information Protection Act 1998
(NSW), you are advised that all application forms received by Council will be placed on the appropriate Council
file and may be disclosed to Councillors, Council officers, consultants to Council or members of the public.
Pursuant to the provisions of the Government Information (Public Access) Act 2009, Council is obliged to allow
inspection of its documents, including any application you make. However, should you wish for your contact
details to be suppressed, please indicate such on the application form.
Lodgement / Payment Information
Lodgement
Lodging an application requires this completed application form to be submitted to Council along with all relevant
information and the payment of the required fee (if applicable).
Lodge in person – Council’s administration building, 7-15 Wetherill St, Leichhardt.
Council’s opening hours are Monday - Friday, 8.30am – 5.00pm, cashiering hours are Monday - Friday,
8.30am - 4.30pm. Please note applications must be lodged by 4.30pm.
Lodge by mail – Leichhardt Council, PO Box 45, Leichhardt NSW 2040
Lodge via email – records@lmc.nsw.gov.au
Payment Options
In person – cash, cheque, EFTPOS, credit card
(0.8% charged on credit card payments; MasterCard and Visa only).
By mail/Email – Cheque or complete the Credit Card Authorisation form –
located on Council’s website under About Council / Forms / General Forms.
Please make cheques payable to Leichhardt Council.
Office use only
Cashier Code: R/2015/
Amount Paid:
Date:
Receipt No:
Initial of CS Officer:
PO Box 45, Leichhardt NSW 2040 | Ph: (02) 9367 9222 | Fax: (02) 9367 9111 | Email: leichhardt@lmc.nsw.gov.au
Road Works Application Form | Updated: June 2015 | Page 3 of 3
