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Dust Control Application Form

  1. I, the undersigned, hereby apply to the County of Wetaskiwin No. 10 for one application of Dust Control for the purposes of controlling dust along a local road adjacent to the land described below and I hereby acknowledge that I have been advised of and agree with the following conditions outlined in the Dust Control Policy.
  2. Quadrant / Section / Township / Range / W 4 or 5 M
  3. Blue Sign
  4. Metres
  5. $6.50/metre x 5% GST = amount to be paid
  6. $6.50/metre x 5% GST = amount to be paid
  7. Confirmation Number or Transaction ID Number
  8. Waiver
    I hereby remise, release and forever discharge the County, its officers, contractors, agents, servants, successors and assigns of and from all manner of actions, causes of actions, suits, debts, dues, accounts, covenants, contracts, claims and demands whatsoever which I shall or may have by reason of any cause, matter or thing, whatsoever, and without limiting the generality of the foregoing, from all claims for damages arising in any way whatsoever from the application of dust control material as described herein.
  9. Collection of Personal Information
    The personal information on this form is collected under the authority of Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act. The information will be used to process your application(s) and your name and address may be included on reports that are available to the public. If you have any questions on the collection and use of this information, please contact the FOIP Coordinator at (780) 352-3321.
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  11. This field is not part of the form submission.