Required fields are marked with asterisks (*)

Request for Temporary Road Closure

Description of event/reason for road closure:

Road to be closed including section:

Date closure required:

Start time:

End time:

Group/contact person making request:

Telephone number:

Event Organizer Approval

I/We, hereby accept responsibility for ensuring all conditions for the abovementioned temporary road closure as required in the Municipality of Northern Bruce Peninsula By-law 2003-26 as follows:

"THAT the Manager of Public Works of the Municipality of Northern Bruce Peninsula, or his designate, may approve a temporary road closure of any highway or any portion of a highway to facilitate a social, recreational, community, athletic, cinematographic purpose, any combination of such purposes, or any other similar purpose, conditional on any such highway requiring County of Bruce approval, and shall ensure the responsibility for notifying the public, establishing suitable detour roads, erection and removal of barricades and signs, maintenance and restoration of the road and detour roads."

Authorized signature:

Clear

Name:

Position:

Date of signing:

Municipal Approval

Signature of Municipal Official:

Clear

Name:

Position:

Date:

Personal information collected on this form is collected under the authority of the Municipal Act, 2001, and will be used for the purpose of responding to your request. Questions regarding the collection of personal information should be directed to the Clerk at 1-833-793-3537 ext. 236.