Isle of Wight Council

	APPLICATION FOR CONSENT TO CONDUCT WORKS ON EXISTING APPARATUS SECTION 50, NEW ROADS AND WORKS ACT 1991 SWL3
	(NB Those applicants not familiar with the requirements of this legisation are strongly advised to appoint a contractor with the approriate knowledge to help complete this application and to conduct the works on their behalf) Non-compliance with any requirement of the New Roads and Street Works Act 1991 may result in sever financial penalties. Please see the Notes for Guidance which requires Adobe Acrobat reader

SWL Ref................................

Section 1 Owner of Apparatus

Title

	Forename
	Middle name/Initials
	Surname

	Building/house name/number
	Street address
	Town name
	Postcode
	Work telephone number (include area code)
	Home telephone number (include area code)

	Section 2  Precise location of Proposed Works
	Tick boxes where necessary. Detailed plan may be requested on receipt of this form.

	Property reference
	Road/Street
	District/Parish/Ward
	City/Town/Village
	Postcode
	National Grid Ref:

	Category of works
	Emergency Urgent
	Minor with excavation Minor without excavation Standard works Major project

	Type of works
	Estimated length of works (m)
	Average depth of excavation	Up to 1.5 m Over 1.5 m Works with no excavation
	Proposed start date	/     /           (dd/mm/yyyy)
	Planned finish date	/     /           (dd/mm/yyyy)
	Estimated duration	hours days months
	Hours of working	Daylight 24 hours Night time AM only PM only
	Work lies within	Verge Footway Carriageway All
	Proposed flow control	Stop/go boards Temp traffic signals Road closure Priority flow Not to be used

Section 3 Details of Person Conducting the Works

Title

	Forename
	Middle name/Initials
	Surname

	Building/house name/number
	Street address
	Town name
	Postcode
	Work telephone number (include area code)
	Home telephone number (include area code)

	Section 4 Insurance
	Public Liability Insurance of a minimum of �5m must be provided up to completion of the permanent reinstatement. (Proof to be submitted with this form).

Company name

	Building/house name/number
	Street address
	Town name
	Postcode
	Work Tetelephone number (include area code)
	Policy number
	Expires (date)

	Section 5  Declaration by Owner of Apparatus (As per Section 1)
	I confirm that the foregoing details are correct, and acknowledge that the works referred to above must be conducted in accordance with the requirements of the New Road and Street Works Act 1991, and associated codes of practice, together with any other conditions imposed by the Street Authority in the relevant licence. I also acknowledge the statutory need for me to pay the prescribed inspection fees which will be imposed by the Street Authority, including any defect inspection fees and the cost of any necessary remedial works conducted by the Street Authority during the guarantee period. I also acknowledge that the licence is granted on the condition that I will indemnify the Street Authority against any claim in respect of injury, damage or loss arising out of: (a) The placing or presence in the street of apparatus to which the licence relates, or (b) The execution by any person of any works authorised by the licence. I also acknowledge that I have read and understand the Notes for Guidance contained in Part 1 (Form SWL1) Signed ............................................................................... Name................................................................................. Date...................................................................................

Section 6 Conditions

1. All highway openings (carriageway, footway or verge) are to be reinstated in compliance with the New Roads and Street Works Act (HMSO publication 'Specification for the Reinstatement of Openings in Highways' refers) other than by prior agreement with this Authority. Further advice and a detailed specification can be provided on request. 2. Signing, guarding and traffic management provision is to comply with Chapter 8 of Traffic Signs Manual 1991, other than by prior agreement with this authority. HMSO booklet 'Safety at Street Works and Road Works - a code of practice' refers.

Signed ............................................................................... Name................................................................................. Date................................................................................... On behalf of Street Authority

IMPORTANT

All communications relating to this license should be addressed to: All communications relating to this license should be addressed to: Highways & Transport County Hall Newport Isle of Wight PO30 1UD Phone Number � 01983 823777 Email address � [email protected] Fax number - 01983 823755 Tel (01983) 823777 Fax (01983) 823545 Email [email protected]

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy. Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013