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CONSTRUCT IN RIGHT-OF-WAY

Applicant Information

Prime Contractor

NOTE:  The applicant is required to carry a minimum of five million dollars ($5,000,000) public liability insurance and property damage insurance with the District of Lake Country saved harmless and named "additionally insured" and provide a current copy of their WorkSafeBC clearance letter.

Required Attachments

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Engineering Consultant

Traffic Control Supervisor

NOTE: Prime Contractor is to immediately notify District Engineer of any change in contact information.

Property Information

Provide Work Schedule Detail as required

NOTE: “End Date” is the date when permanent surface restoration is complete and contractor has notified the District Engineer.

Excavated Site Surface Material(s): (check all that apply)

Asphalt
Concrete
Other

Traffic Information (Use additonal sheet if more than one road)

Where on roadway
Condition(s)
Submit Traffic Control Plan Detail (if applicable) or upon request of the District Engineer

Other Attachments 

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Locates are required prior to excavating under the terms of the Permit to Construct in the Right-of-Way and WCB/Worksafe Occupational Health and Safety Regulations. Failure to do so will invalidate the Permit.

By entering your name and date below you are acknowledging you have read and understood the District of Lake Country Permit Conditions and agree to be bound by its provisions and amendments, specifications and regulations governing excavations in or under municipal streets and to such special conditions, restrictions and regulations as may be imposed by the District Engineer.



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© 2018 District of Lake Country, 10150 Bottom Wood Lake Road, Lake Country, BC V4V 2M1, Telephone 250-766-5650, Fax 250-766-0116

Hours of Operation: 8:30 am to 4:30 pm Monday to Friday excluding statutory holidays

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