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

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field