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Application Form CIS 2022-2023.Pdf Roads Section, Tel: 0761 06 5000 Civic Offices, Limerick Road, Nenagh. E-mail: [email protected]. For Office use only Ref No. ___________ APPLICATION FORM COMMUNITY INVOLVEMENT SCHEME LATEST DATE FOR RECEIPT OF COMPLETED APPLICATION IS FRIDAY 6th AUGUST, 2021 @ 12 Noon. Please read the attached Explanatory Memorandum before completing this Application Form. Please ensure that all questions are completed fully Details of Road A. Townland(s)/Location of road: ___________________________________________________________________ B. Length of road to be included in scheme: __________________________________ C. Width of road between fences: __________________________________________ D. No. of residents on road: ______________________________________________ E. No. of landowners other than residents on road: ____________________________ F. Road Number: _________________ G. Description of road – whether through road or cul-de-sac: _____________________ H. Municipal District: Carrick on Suir Clonmel Nenagh Thurles Tipperary/Cahir/Cashel 1 | P a g e Details of Works to be carried out. _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Note: A local financial contribution of 10% of the total estimated cost of the works as determined by the Council’s Engineer is required. The Council will carry out all of the approved works, subject to availability of Grant funding. Please attach copy of 6" O.S. Map or similar indicating location of road. Your application will be returned in the absence of a map identifying the proposed road to be included in CIS. I, the undersigned have been appointed to act as representative for the local community in respect of this application. I certify that the information on this application form is correct. (Please complete in block letters) Name (in Block Capitals): _________________________________________________ Appointed Representative Tel. No. _____________________ Mobile No. _______________________ Address: _________________________________________________________ ________________________________________________________________ Eircode: __________________ E-mail ________________________ Date: ______________________ Signed: ____________________________________ Appointed Representative Privacy and Data Protection: Personal information collected by Tipperary County Council is done so in order for us to process your application. Legally we can process this information as it is necessary for us to comply with our statutory/legal obligations in accordance with the Community Involvement Scheme. The protection of your personal data is a key priority for the Council and your data will be processed in line with our Privacy policy which is available at https://www.tipperarycoco.ie/your-council/privacy-statement or hardcopy form from our offices at Tipperary County Council, Civic Offices, Limerick Road, Nenagh, Co. Tipperary. Should you have any questions about our privacy policy or the information we hold about you, please contact us by email to [email protected] or write to us at Data Protection, Tipperary County Council, Civic Offices, Emmet Street, Clonmel, Co.Tipperary. 2 | P a g e 1. We, the undersigned, being members of the local community in the townland of _____________________________________________ hereby apply to Tipperary County Council for participation in the scheme to improve local PUBLIC ROADS in 2022/2023. 2. We hereby appoint and delegate full power to _______________________ (Appointed Representative) of ______________________________________ to act for us in all correspondence and other business arising out of this application and we agree to be bound by our nominee’s correspondence and acts. 3. Should our application be successful, we agree to submit the relevant financial contributions within the specified timeframe outlined in writing on the approval letter. We understand that if we do not submit financial contribution during that period, the application will no longer be considered and an offer will be made to the next applicant on the list. We also understand that responsibility for collection of the local contribution lies with the appointed representative who must lodge the full amount with one of Tipperary County Council Cash Desks at Nenagh, Clonmel or any Municipal District Office, within the specified timeframe which will be outlined in the letter of offer. Payments can also be made by Bank Transfer or Card Payments via telephone. 4. The Council undertakes to use its best endeavours to hold confidential, any information provided by you in this application form subject to the Council’s obligations under law, including the Freedom of Information Act (as amended). Should you wish that any of the information supplied by you in this application not be disclosed, because of its sensitivity, you should, when providing the information, identify same and specify the reasons for its sensitivity. 5. Completed application forms MUST be submitted to the Roads Department, Civic Offices, Limerick Road, Nenagh, Co. Tipperary no later than 12 noon on Friday 6th August, 2021, or to e-mail address: [email protected] 6. This Scheme applies to PUBLIC ROADS only. CLOSING DATE FOR RECEIPT OF COMPLETED APPLICATION FORM TH FRIDAY 6 AUGUST, 2021 AT 12 NOON. 3 | P a g e NAMES OF ALL APPLICANTS NAME ADDRESS & EIRCODE SIGNATURE 4 | P a g e TIPPERARY COUNTY COUNCIL COMMUNITY INVOLVEMENT SCHEME EXPLANATORY MEMORANDUM GENERAL CONDITIONS OF THE SCHEME. 1. The Community Involvement Scheme is a joint venture approach between the Council and local communities, for the purpose of carrying out maintenance and improvement works on suitable local public roads. 2. Applications will be assessed and cost estimated by Tipperary County Council and prioritised in accordance with the terms of the Scheme. 3. The value of the contribution by the local community will be 10% of the estimated cost of the Scheme, as determined by the Council’s Engineer. Tipperary County Council will only accept monetary contributions in advance from the community and will carry out all of the approved works on the Scheme, on payment of the required amount. Full details of terms and conditions will be outlined in writing including financial contributions applicable to all successful applicants. The CIS Scheme is subject to funding being available to the Council. 4. Section 70 of the Roads Act 1993 obliges landowners and occupiers of land to take all reasonable care to ensure that structures, trees, hedges and other vegetation on their land are not, or could not become, a danger to people using or working on a public road. 5. Section 76 of the Roads Act 1993 obliges landowners and occupiers of land to take all reasonable steps to ensure that water can drain off a public road on to their land and to ensure that water, soil or other materials do not escape from their land/property on to the road. 6. The Council may decide not to proceed with the Scheme if: a) The statutory obligation outlined in 4 and 5 above are not met, b) The local contribution is not paid in full in accordance with the terms and conditions on the letter of offer, or c) The Council has no matching grant funding to proceed. 7. It is a matter for the Community to agree on the amount each participant contributes. If individual participants wish to make separate payments to the Appointed Representative, these will be accepted by the Council and separate receipts issued. However, all payments must be made on the same date by the Appointed Representative to the Cash Office in Tipperary County Council’s Civic Offices or Municipal District Offices, or by Bank Transfer / Card Payment. 5 | P a g e 8. The Scheme will be administered by each District Engineer’s office, and the appointed representative can liaise with the relevant District Engineer regarding their application. 9. Completed applications and map should be returned to the Roads Department, Tipperary County Council, Civic Offices, Limerick Road, Nenagh, Co. Tipperary, no later than 12 noon on Friday, 6th August 2021, either in hard copy or to e- mail address: [email protected] 6 | P a g e .
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