= Required Fields

Online Form - Permit to Undertake Works on Public Land Request

This form is to be used to request authority to undertake works on land under the management of the Shire of Wyndham East Kimberley.

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You have the ability to save this form and complete it at a later date. An email will be generated and sent to the specified address.

Note: Incomplete forms are kept for a period of 2 day(s) hour(s), after this time the system will automatically delete your response.

Applicant Details

Postal Address
Residential Address

Details of Proposed Works

Please include location information and specific details of the proposed works including dimensions and any known impacts on other infrastructure and users of the land.
• Drawings, mud map or aerial image may be attached to fully describe the proposed works.
• Copies of current Public Liability and Workers Compensation certificates must be attached.
• Where required, a Traffic Management Plan certified by a person accredited to make and approve such plans must be attached.
• Copies of qualifications or accreditation's shall be where works require such qualifications must be attached.

Address

By submitting this form the applicant agrees to provision of a defects liability period of 12 months from the certified date of practical completion for any reinstatement works.


 
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