PO Box 99
Kalgoorlie WA 6430
Phone: 9080 1400
Fax: 9080 1452 /
application for ACCESS POINT
Applicants Details:
Name: / Position:
Company: / Phone:
Address: / Fax:
Email:
Access Point DETAILS:
Location Description: / Road:
□ New Access / □ Existing Access
Access Type:
(Specify Primary Business Activity) / □ Residential Access
□ Recreational
□ Maintenance / □ Agricultural Access
□ Commercial
□ Mining / □ Emergency
□ Pedestrian / Cycle
□ Other
Access Description:
(use, size)
Access Operation Period: / □ 3 Months / □ 6 Months / □ 1 Year / □ 2 Years / □ 3 Years
□ Other:
Operation Times: / □ 12 hours (6am to 6pm) / □ 24 hours / □ Other:
Proposed Commencement Date:
Please include relevant map, photo or sketch (below or attached):
Typical Traffic Flow ENTERING The ACCESS POINT
Daily Volume
On Typical Busy Day / Tick relevant box(s) to indicate average DAILY traffic flow ENTERING access point
0–10 / 11–20 / 21–50 / 51–100 / 101-200 / >200
Cars & 4WD’s
Small Trucks
Semi Trailers
Road Trains to 36.5m
Road Trains to 53.5m
Is there a peak period for traffic entering the access point? / If so please provide details ( month, day, time of day ( AM / PM etc.) & No. of Vehicles
Predominant Turning Movement: / □ LEFT from highway / □ RIGHT from highway / □ No Pattern
Typical Traffic Flow LEAVING The ACCESS POINT
Daily Volume
On Typical Busy Day / Tick relevant box(s) to indicate average DAILY traffic flow LEAVING access point
0–10 / 11–20 / 21–50 / 51–100 / 101-200 / >200
Cars & 4WD’s
Small Trucks
Semi Trailers
Road Trains to 36.5m
Road Trains to 53.5m
Is there a peak period for traffic leaving the access point? / If so please provide details ( month, day, time of day ( AM / PM etc.) & No. of Vehicles
Predominant Turning Movement: / □ LEFT from highway / □ RIGHT from highway / □ No Pattern
I / we agree that if approval to this application is granted, I / we will comply with the requirements set out in the Conditions of Agreement. I / we understand that failure to comply with these requirements may result in closure of the access point by Main Roads WA.
Signature of Applicant: / Date:Enquiries related to this application can be directed to the Network Operations Manager on 9080 1400
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