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Welcome
Road Occupancy Permit Application Form.
County of Haliburton
Public Works Department.
11 Newcastle Street, Minden, ON. K0M 2K0
Phone: 705-286-1762
APPLICANT DATA
Last Name:
Given Name(s):
Address:
City/Town:
Postal Code:
Telephone:
Date of Application:
Applicant Signature:
Clear
OCCUPANCY TYPE:
OCCUPANCY TYPE:
Geotechnical/ Survey
Special Event
Forestry/Tree Trimming
Event/Parades
Construction
Planting/ Beautification
Utility Repair
Utility Installation
Fencing Installation
Other Encroachment
LOCATION DESCRIPTION
County Road Number:
Municipality:
Lot:
Concession:
Nearest Intersection:
Nearest Civic Address
Date Required
Date Required From:
Date Required To:
Duration of Date required:
Primary Contact:
Cell Number:
GENERAL DESCRIPTION OF ACTIVITY:
Traffic Control Plan:
Traffic Control Plan:
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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif
Proof of Insurance:
Proof of Insurance:
Yes
No
COUNTY OF HALIBURTON ROADS DEPARTMENT
Minden, ON K0M 2K0
Phone: 705-286-1762
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