Dust Suppression Application Form 2025

Please Click Here for the Hold Harmless Agreement

<form-template>
	<fields>
		<field type="paragraph" subtype="blockquote" label="Dust Suppression Application: Applications must be made prior to May 15th of the current year. Applications must be made yearly. (Please note that this form will be taken off the website after May 15th, no requests will be accepted until January of the following year)." class="paragraph"></field>
		<field type="paragraph" subtype="blockquote" label="Application width will be one (1) pass 7 meters wide. " class="paragraph"></field>
		<field type="paragraph" subtype="blockquote" label="Notes:     Hold harmless agreements must be signed. If you have already please note on form.   Hold Harmless agreements can be found on the County of Warner No.5 website.      Applications to be made before May 15 of the current year.      Dust control limits are up to 200 Meters  as per policy 320.51. Dust  suppression cost is $5.00 per lineal meter single application. Application will start in June pending delivery." class="paragraph"></field>
		<field type="paragraph" subtype="blockquote" label="Agreements will be mailed back with invoice after work has been completed." class="paragraph"></field>
		<field type="paragraph" subtype="blockquote" label="Dust Suppression Cost  200 x $5.00=$1000. $1000.00 plus GST ($50.00)=$1050.00" class="paragraph"></field>
		<field type="paragraph" subtype="blockquote" label="The County will be responsible for the maintenance of the dust control adjacent to the property or residence for the current year. The County reserves the right to grade any sections of dust suppression product during its normal grading operations when deemed necessary for road conditions that present a risk to general traffic using said roadway. Doing so does not obligate the County to reapply the dust suppression until next application period. There is no guarantee of the life expectancy of the dust suppressant. " class="paragraph"></field>
		<field type="date" required="true" label="Today's Date" description="What day you filled out this application " class="form-control calendar" name="date-1714604873392"></field>
		<field type="text" subtype="text" required="true" label="Name" placeholder="First, Last Name" class="form-control text-input" name="text-1714604916307"></field>
		<field type="header" subtype="h1" label="Billing Address" class="header"></field>
		<field type="text" subtype="text" required="true" label="Box Number" description="Box #" placeholder="Box Number" class="form-control text-input" name="text-1714604969193"></field>
		<field type="text" subtype="text" required="true" label="Town " description="Town or Village" placeholder="Town or Village" class="form-control text-input" name="text-1714605007401"></field>
		<field type="text" subtype="text" required="true" label="Province" placeholder="Province" class="form-control text-input" name="text-1714605048452" value="Alberta"></field>
		<field type="text" subtype="text" required="true" label="Postal Code" placeholder="Postal Code" class="form-control text-input" name="text-1714605096630"></field>
		<field type="text" subtype="email" required="true" label="Email" placeholder="Email" class="form-control text-input" name="text-1714605122344"></field>
		<field type="text" subtype="text" required="true" label="Phone" placeholder="Phone Number" class="form-control text-input" name="text-1714605154778"></field>
		<field type="text" subtype="text" required="true" label="Rural Address" description="Blue Sign on your lane way" placeholder="Rural Address Number" class="form-control text-input" name="text-1714605187608"></field>
		<field type="select" required="true" label="Number of Meters" description="Length in Meters max 200" class="form-control select" name="select-1714605229444">
			<option value="100 Meters" selected="true">100 Meters</option>
			<option value="200 Meters">200 Meters</option>
		</field>
		<field type="header" subtype="h3" label="Legal Land Description" class="header"></field>
		<field type="select" required="true" label="Quarter" class="form-control select" name="select-1714605323005">
			<option value="NE" selected="true">NE</option>
			<option value="NW">NW</option>
			<option value="SE">SE</option>
			<option value="SW">SW</option>
		</field>
		<field type="text" subtype="text" required="true" label="Section" placeholder="Section" class="form-control text-input" name="text-1714605389054"></field>
		<field type="text" subtype="text" required="true" label="Town Ship" placeholder="Town Ship" class="form-control text-input" name="text-1714605411780"></field>
		<field type="text" subtype="text" required="true" label="Range" placeholder="Range" class="form-control text-input" name="text-1714605439089"></field>
		<field type="text" subtype="text" required="true" label="Meridian" description="W4" placeholder="Meridian" class="form-control text-input" name="text-1714605466804" value="W4"></field>
		<field type="radio-group" required="true" label="Hold Harmless agreement complete" class="radio-group" name="radio-group-1714605523977">
			<option value="Yes" selected="true">Yes</option>
			<option value="No">No</option>
		</field>
	</fields>
</form-template>

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