Vehicular Crossing Permit Application

VCP / / OFFICE USE ONLY

Use this form to construct, relocate, widen, reinstate or remove a vehicle crossing or any footpath panel.
Applicants should refer to the Vehicular Crossings Procedures available on the Boroondara website.
For assistance with this form call Asset Management on 9278 4505 or refer www.boroondara.vic.gov.au

SITE DETAILS
Property Address:
A DETAILED SITE PLAN MUST BE ATTACHED TO THIS APPLICATION - REFER TO SITE PLAN REQUIREMENTS OVERLEAF

TYPE OF PROPERTY
Single Residential Dwelling Subdivision Proposal
Townhouses or Unit Development Commercial or Industrial Site
Other (specify) :

NATURE OF WORKS (tick all applicable)

Modify or widen existing crossing Construct new crossing
Relocate existing crossing Construct second crossing
Remove redundant crossing Repair existing footpath or kerb
Repair existing crossing Other (specify) :

PLANNING DETAILS
P1 Is the property subject to a planning overlay ? (REFER NOTE 5 OVERLEAF) Yes No
P2 Will the crossing connect to an arterial road ? (REFER NOTE 6 OVERLEAF) Yes No
IF YOU ANSWERED ‘Yes’ TO EITHER P1 OR P2,
ATTACH A COPY OF THE ENDORSED PLANS TO THIS APPLICATION AND ENTER THE PLANNING PERMIT NUMBER BELOW

Planning Permit No:

APPLICANT DETAILS
Company Name (if applicable) : ABN:

Applicant Name: Mr / Ms / Mrs

Role (tick one) : Property Owner Builder / Agent Contractor (3rd Party)

Postal Address:

Phone:

Email:

DECLARATION (by Applicant)

By signing this document I declare that:
i. I have read and understood both sides of this form including Council’s Privacy Statement overleaf;
ii. I have attached all required documentation including payment;
iii. All details disclosed in this application are true and correct to the best of my knowledge.

Signature: Date:
 Case : Receipt : Officer ID:

SITE PLAN REQUIREMENTS

The site plan should clearly identify:

□ The location of any existing crossing(s) to the property.
□ The location of all proposed crossing(s) or modifications to existing crossing(s).
□ The name of the street frontage that the proposed crossing(s) is located on.
□ All street assets within proximity of the proposed crossing(s) including street trees, sign posts, power
poles, utility pits, stormwater drains, fire hydrants and neighbouring crossings.
□ The dimensions of the internal parking space and/or garage setback.
Refer to the Vehicular Crossings Procedures document for minimum clearances from all street assets.

APPLICATION INSTRUCTIONS

1. Incomplete applications will not be processed until all documents are provided by the applicant.

2. Applications will be assessed in accordance with the City of Boroondara Vehicular Crossings Policy
and Procedures -
□ Review these documents on our website prior to lodging this application.

3. Applications will be subject to an onsite assessment -

□ Allow 10 business days for the application to be assessed and a permit issued or refused.
□ A non-refundable administrative fee is payable with this application.
□ Please refer to the attached payment form for our current fee and payment options.

4. Applications may be referred to another Department (such as Parks & Infrastructure or Drainage) -
□ Applicants will be notified via email if applications are delayed due to referral.
□ Allow an additional 10 business days if endorsement is required.

5. Applications for a site within a Planning Overlay (e.g. Heritage) may first require a Planning Permit -
□ An applicant should first contact Council’s Statutory Planning Department on 9278 4888.
□ If a permit is obtained, a copy of the endorsed plan must be provided with this application.

6. Applications for sites on arterial or state-managed roads may first require a Planning Permit -
□ Refer to the VicRoads website, or call 131171, to verify if the proposed site is located on such a road.
□ Contact our Statutory Planning Department on 9278 4888.
□ If a permit is obtained, a copy of the endorsed plan should be attached to this application.

7. Applicants may request a quote for Council’s contractors to carry out the approved works -
□ Applicants should put such a request in writing and submit same with this application.
□ If a permit is issued, a quotation with payment form will be sent with the permit to the permit holder.
□ If accepted, Council will schedule the works for a date 6 to 8 weeks from receipt of full payment.

8. When issued, the Vehicular Crossing Permit with Construction Specifications will be emailed to the
address provided by the applicant unless otherwise requested -
□ A copy of these should be forwarded to the contractor constructing the crossing, for their reference.
□ Applicants wanting to be sent hard copies of these should request same in writing at lodgement.

9. Permits are valid for 18 months from date of issue, are not transferable and cannot be extended.

Privacy Statement: The personal information requested on this form is collected by the City of Boroondara for the purpose of implementing Council’s Vehicular Crossing
Policy and associated Procedures in assessing a Vehicular Crossing Permit application. The information will be used by Council for that primary purpose or directly related
purposes but may also be used to update Council’s customer databases to assist Council in discharging its functions or providing services. The personal information
collected will not otherwise be disclosed unless permitted or required by law. Requests for access to, and/or amendment of, personal information should be made to
Council's Privacy Officer.
Credit Card or Cheque
Payment Form
Forward payments to:
Mail - City of Boroondara, Private Bag 1, Camberwell VIC 3124
Email - boroondara@boroondara.vic.gov.au
Fax - 03 9278 4466

OFFICE USE ONLY

Applicant Name: MIT: ______________
Site Address:
REC:___Infring or GL
Payment type: Credit Card Cheque
RECEIPT: ___________
Payment for: Vehicular crossing permit application
AMT PAID $__________
Department: Asset Management
PAYER: _____________
Fee: $205.00 (fee valid until 30 June 2018)

RC Code: 223

Credit Card holder to complete

Cardholder name:

Mailing address:

Telephone number:

.......................................................................................................................................................................

Credit Card details

Card type: Visa Mastercard Amex Diners

Credit card number: / / /

Expiry date: /

I, , hereby authorise the City of Boroondara to charge the

(Cardholder’s full name - please print clearly)

amount of $205.00 (plus applicable credit card surcharge) to my credit card for the purposes stated above.

Signature: Date: / /
CREDIT CARD SURCHARGE: Payments made by credit card will incur a Credit Card Surcharge equivalent to the Merchant Service
Fee imposed upon Council by the credit card provider. The surcharge applicable to each card type is: Visa - 0.38%, Mastercard -
0.38%, Diners Club - 1.47%, Amex- 1.48%.
PRIVACY STATEMENT: The personal information requested on this form is being collected by Council for the purpose of charging
fees in relation to the above service. The personal information will be used by Council for that primary purpose or directly related
purpose. The personal information collected will be disclosed to Council's bank or other financial institution for the purpose of
processing payments and will not otherwise be disclosed unless required by law. If the information is not collected an alternative
payment method will be required before your service request can be processed. The applicant understands that the personal
information provided is for the purpose of charging fees and that he/she may apply to Council for access to and/or amendment of the
information. Requests for access and /or correction should be made to Council’s Privacy Officer.
SUBMITTING YOUR DOCUMENTS TO COUNCIL -

Applications with cheque or money order payments should be mailed to:

City of Boroondara
Private Bag 1
CAMBERWELL VIC 3124

Applications may be lodged in person at Council’s:

Customer Service Centre

8 Inglesby Road, CAMBERWELL

between 8.45am and 5pm Monday to Friday.

Payments can be made by Cash, Cheque, EFTPOS or Credit Card.

Applications with credit card payment can be faxed to::

City of Boroondara
Asset Management
(03) 9278 4466

Scanned applications with credit card payment can also be emailed to:

boroondara@boroondara.vic.gov.au

This method is the fastest way to have your application assessed.