Application for Clearance Certificate for Restricted Access Vehicles

/ ADELAIDE HILLS COUNCIL

APPLICATION FOR CLEARANCE CERTIFICATE FOR RESTRICTED ACCESS VEHICLES

(FOR ACCESS TO ADELAIDE HILLS COUNCIL ROADS)

TO BE COMPLETED BY THE APPLICANT

I/We......

(Name of Applicant)

For and on behalf of......

(Company/Business)

Of......

(Business Postal Address)

Telephone...... Facsimile......

Email......

Hereby make application to the Adelaide Hills Council to operate the following Restricted Access Vehicle/s:

□23m B-Double□32m A-Double□53.5m A-Triple

□25m B-Double□36.5m A-Double□23m Truck & Trailer

□Controlled Access Bus□Crane□Low Loader

□Other(please specify)......

Vehicle MakeRegistration NoDimensions

(attach diagram where possible)

......

Vehicle CombinationNo. of TrailersNo. of AxlesWeight

......

On the following Council Road/s (include map and/or diagram and show direction of travel nominating left and right turns if applicable)

Note: specific roads must be detailed below, for a certificate to be issued.

......

Roads approved by: …………………………………………......

(Council use only)(name)(Signature)(Date)

For the purpose of

......

Date/s and Time/s of proposed Access..../.../... to .../..../....

Between ...... a.m. / p.m. and ...... a.m. / p.m.

This clearance Certificate –

A.Is NOT a PERMIT to access the Council road(s):

B. MUST be forwarded to Transport SA by the Applicant to obtain a PERMIT from Transport SA:

C. Is issued at the discretion of Adelaide Hills Council and may be revoked at any time by Council as a result of changing conditions:

D. May be revoked at any time by Adelaide Hills Council for any breach of the Terms and Conditions by theApplicant.

Terms and Conditions of the Clearance Certificate –

The Applicant agreeing to indemnify and keep indemnified Adelaide Hills Council against all actions, costs, claims, damages, charges and expenses whatsoever resulting from any act, omission or failure by the Applicant to comply with these Conditions of Clearance or any Special Conditions of Clearance contained herein;
Only those roads included in this Clearance Certificate and the Permit issued by Transport SA may be accessed by the Restricted Access Vehicle/s identified on this Clearance Certificate;
Any damage to the road/s and/or infrastructure resulting from access by the Applicant’s Vehicle/s will be repaired at the Applicant’s expense;
Any speed limits imposed within this Clearance Certificate and/or the Permit must be adhered to at all times;
The issuing of this Clearance Certificate does not provide exemptions to exceed mass or designated load limits on bridges, roads or other infrastructure;
Drivers/Operators must avoid all horizontal and vertical obstructions

I/We acknowledge that I/we have read and understand the Terms and Conditions of the Clearance Certificate (including any Special Conditions listed herein) and agree to abide by all such conditions.

Signed for and on behalf of the Applicant/s

Name ...... Position ......

Signature ...... Date ...../...... /......

Once completed, please return -

Attn: Executive Assistant,Engineering

Mail Adelaide Hills Council, PO Box 44, Woodside SA 5244

Fax (08) 8389 7440

Note : 5 clear working days are required to process

Restricted load access roads

CorkscrewRoadBridge, Castambul
Teringie Drive, Teringie
Ridgeland Drive, Teringie
Valley Drive, Teringie
Ilinga Avenue, Balhannah
Kurla Road, Balhannah
Talbu Court, Balhannah
Mamara Court, Balhannah
Arrawa Court, Balhannah
Darkana Road, Balhannah
Carawa Avenue, Balhannah
Burns Road, Woodside
Unkuala Avenue, Balhannah
Lower Hermitage Road, Lower Hermitage
Retreat Valley Road, Gumeracha
Nairne Road, Balhannah / Malanilla Court, Balhannah
Ridge Rd, Lobethal
Post Office Rd, Lobethal
Miller Road, Lobethal
Bartholomew Avenue, Lobethal
ArburyParkBridge, Aldgate
SomersetRoadBridge, Aldgate
Forbes Road, Aldgate
GladesLaneBridge, Aldgate
ShanksRoadBridge, Aldgate
Sturt Valley Rd Bridge (near Whitewood Drive), Upper Sturt
AccessBridge to Kyle Road, Mylor
Onkaparinga Road Bridge, Bridgewater
Swamp Road Bridge, Uraidla
Holland Creek Road, Cudlee Creek

P:\AHC\Engineering\Heavy Vehicle Permits\140224 frm heavy vehicle application.doc