Municipality of Cartwright-Roblin

Use the form below to request municipal services related to:

• Streets, roads, trails and back lanes
• Culverts and bridges
• Field or yard access approaches
• Signs (traffic or civic address)
• Cartwright water & sewer
• Other: facility buildings, cemeteries, parks & structures, trees, noxious weeds, beaver activity on municipal road allowances, approved private work
• Drainage/ MB Water Control Works licenses: (Manitoba regulates surface and tile drainage, culverts, dams, and ditch reshaping. Contact Manitoba Environment & Climate Change before submitting a municipal work request.

<form-template> <fields> <field type="paragraph" subtype="blockquote" label="Requests are forwarded to Public Works and added to the next Council meeting agenda for review. " class="paragraph"></field> <field type="date" required="true" label="Date Submitted " description="mm/dd/yyyy" class="form-control calendar" name="date-1656967815487"></field> <field type="text" subtype="text" required="true" label="Applicant Name (AND Owner's Name if different)" class="form-control text-input" name="text-1656967798442"></field> <field type="text" subtype="email" label="Email Address (or n/a)" class="form-control text-input" name="text-1656967830724"></field> <field type="text" subtype="text" required="true" label="Phone 204-000-0000" class="form-control text-input" name="text-1656967848943"></field> <field type="text" subtype="text" required="true" label="Is this a first submission or resubmission? (1st/ Resubmit)" description="Yes or No" class="form-control text-input" name="text-1724944758760"></field> <field type="text" subtype="text" required="true" label="Work Location (include all: Civic/Yard Sign Number, Road Number, Legal Description, special directions)" class="form-control text-input" name="text-1656967980480"></field> <field type="checkbox-group" required="true" label="Work Request for: (check items needed)" class="checkbox-group" name="checkbox-group-1769720399934" enable-other="true" other="true"> <option value="Road, trail, street, or back lane - maintain or upgrade">Road, trail, street, or back lane - maintain or upgrade</option> <option value="Rural driveway blading (summer only, 1 free)">Rural driveway blading (summer only, 1 free)</option> <option value="Snow clearing on seasonal roads (e.g. to grain bins)">Snow clearing on seasonal roads (e.g. to grain bins)</option> <option value="Culvert or bridge - maintain or replace">Culvert or bridge - maintain or replace</option> <option value="Sign (traffic, civic, address, other) - maintain or replace">Sign (traffic, civic address, other) - maintain or replace</option> <option value="Building, structure, equipment, other - maintain or replace">Building, structure, equipment, other - maintain or replace</option> <option value="Cartwright water service - connect or disconnect">Cartwright water service - connect or disconnect</option> <option value="Add gravel to access approach $0">Add gravel to access approach $0</option> <option value="New first access approach (with or without culvert) $0">New first access approach (with or without culvert) $0</option> <option value="New additional access approach (no culvert) $1600">New additional access approach (no culvert) $1600</option> <option value="New additional access approach (with culvert) $2100">New additional access approach (with culvert) $2100</option> <option value="Widen first access approach (no culvert) $700">Widen first access approach (no culvert) $450</option> <option value="Widen additional access approach (no culvert) $900">Widen additional access approach (no culvert) $900</option> <option value="Widen additional access approach (with culvert) $1400">Widen additional access approach (with culvert) $1400</option> <option value="Drainage: surface or tile, culverts, dams">Drainage: surface or tile, culverts, dams</option> </field> <field type="textarea" label="Work details, including distance from intersection or other marking point:" class="form-control text-area" name="textarea-1656968137331"></field> <field type="checkbox-group" label="Drainage Details: MB Water Control Works licences are required for work in ditches (e.g. tile or surface outlet drains, culverts, dams, excavation)." description="(click all that apply)" class="checkbox-group" name="checkbox-group-1769720879654"> <option value="YES - Applicant contacted MB Conservation and Climate Change regarding a WCW license.">YES - Applicant contacted MB Conservation and Climate Change regarding a WCW license.</option> <option value="YES - Applicant contacted upstream/ downstream landowners to explain the proposal.">YES - Applicant contacted upstream/ downstream landowners to explain the proposal.</option> </field> <field type="text" subtype="text" label="List upstream/ downstream landowners and their responses (Name, In support, Opposed)." description="Name, in support or opposed." class="form-control text-input" name="text-1656968225445"></field> <field type="text" subtype="text" required="true" label="I understand that my project may incur costs which I may be invoiced for. (Yes / No)" class="form-control text-input" name="text-1658945728243"></field> <field type="file" label="Upload applicant file(s) or photo(s) here. " class="form-control file-input" name="file-1724682164756" multiple="true"></field> </fields> </form-template>

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