RM OF SHELL RIVER

   RURAL MUNICIPALITY OF SHELL RIVER 

Box 998 , 213 – 2^nd Avenue NW

Roblin , Manitoba   R0L 1P0

(204) 937-4430 (office)

(204) 937-8496 (fax)

                            APPROACH/CULVERT APPLICATION

Application will be brought forth to the next regularly scheduled council
meeting.

Owner:_________________________________________________________

Mailing Address:  _________________________________________________

Phone No. (Residence)  _______   (Business)  _________   (Other)  _________

_______________________________          _______________________
Owner’s Signature                                                Date

PROPOSAL:

Legal Description:  ________________________________________________
                                        (include Road No. where approach/culvert is to be installed)

Reason for the request:___________________________________________________ ____

_____________________________________________________________

_____________________________________________________________

Proximity to other approaches/landmarks:____________________________________________

______________________________________________________________

Size of culvert requested (estimate only):_______________________________

Fill to be hauled from (location):______________________________________

Gravel required (amount):_________________cy 

To be hauled from:_______________________

Installation to be done by:___________________________________________

Owner responsible for:_____________________________________________