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2. Applicants First Name*
3. Applicants Last Name*
5. Business Name*
7. Address1*
9. City*
10. Province*
11. Postal Code*
13. Proposed Start Date*
    Proposed Start Date

    Proposed Start Date
14. Proposed Completion Date*
    Proposed Completion Date

    Proposed Completion Date
16. Road(s) Affected by Closure*
18. Brief Description of Work to be Completed*
20. Has Alberta One Call Been Completed?

    1. Yes
    2. No
    3. N/A
21. Signage Will Be Monitored After Hours, If Required?

    1. Yes
    2. No
    3. N/A
22. Applicants Must Submit the Following Documents*

    1. Traffic Control Plan
    2. Project Schedule
24. Waiver
    I acknowledge that this is an Temporary Road Closure Application Form and acknowledge all terms and conditions of the approval of this application. After the proposed work has been reviewed and found acceptable by the County of Wetaskiwin, this application may then be approved.
26. Protection of Privacy Act

    The personal information collected through this Temporary Road Closure Application form is for the purpose of managing temporary road closure applications within the County. This collection is authorized by Section 4(c) of the Protection of Privacy Act. For questions about the collection of personal information, please contact the County of Wetaskiwin Privacy Officer: email legislativeservices@county10.ca; telephone 780.352.3321.

    
    

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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print