Isle of Wight Council

	Application to Request a Temporary Road Closure(Event)
	Use this form to request permission to temporarily close a road for a public event. ALL FIELDS MARKED WITH A * ARE REQUIRED ENTRIES
	Works Co-ordinator Highways And Transport  County Hall Newport Isle of Wight PO30 1UD Phone Number � 01983 823777 Email address � [email protected] Fax number -01983 823755

Applicant Details

*	Forename
	Middle name/Initials
*	Surname

*	Building/house name/number
*	Street address
*	Town name
	County
*	Postcode
	Telephone number (include area code)
	Email address
	Fax

On Site Contact Details

*

Name

*

Mobile number

Location Details

*	Road names and numbers
	Name of event
*	Reason as to why road closure cannot be avoided
	Estimated number of persons attending event

	Dates and Times of Event
	A minimum of 35 days notice (preferably longer) is required by the Isle of Wight Council prior to the date of a proposed road closure for an event. This is for co-ordination purposes and to allow for the advertising of the necessary traffic order.

	Date	Year Month Day
	Day	Mon Tues Wed Thur Fri Sat Sun
	Time

	Date	Year Month Day
	Day	Mon Tues Wed Thur Fri Sat Sun
	Time

	Date	Year Month Day
	Day	Mon Tues Wed Thur Fri Sat Sun
	Time

	Date	Year Month Day
	Day	Mon Tues Wed Thur Fri Sat Sun
	Time

	Date	Year Month Day
	Day	Mon Tues Wed Thur Fri Sat Sun
	Time

	Date	Year Month Day
	Day	Mon Tues Wed Thur Fri Sat Sun
	Time

Declaration

I hereby apply for permission to request a road closure on the highway and agree to comply with the necessary conditions required by the Isle of Wight Council.

*

Signature

Signed ............................................................................... Name................................................................................. Date...................................................................................

PLEASE NOTE: A minimum of �5 million public liability insurance is required for all events that take place on the public highway. Please fill in and return this form together with a copy of your public liability insurance certificate.

	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