<form-template> <fields> <field type="paragraph" subtype="output" label="Requesting to Close:" class="paragraph"></field> <field type="checkbox" label="Road" class="checkbox" name="checkbox-1655915970934" value="Road"></field> <field type="checkbox" label="Other" class="checkbox" name="checkbox-1655915992710" value="Other"></field> <field type="text" subtype="text" label="Location of Closure:" class="form-control text-input" name="text-1655916017190" value="Location of Closure:"></field> <field type="text" subtype="text" label="Purpose of Closure:" class="form-control text-input" name="text-1655916036966" value="Purpose of Closure:"></field> <field type="text" subtype="text" label="Date of Closure:" class="form-control text-input" name="text-1655916076159" value="Date of Closure:"></field> <field type="text" subtype="text" label="Time of Closure:" class="form-control text-input" name="text-1655916133061" value="Time of Closure:"></field> <field type="text" subtype="text" label="Organization Name:" class="form-control text-input" name="text-1655916175878" value="Organization Name:"></field> <field type="text" subtype="text" label="Contact Name:" class="form-control text-input" name="text-1655916201109" value="Contact Name:"></field> <field type="text" subtype="email" label="Email:" class="form-control text-input" name="text-1655916219173" value="Email:"></field> <field type="text" subtype="text" label="Civic Address:" class="form-control text-input" name="text-1655916247109" value="Civic Address:"></field> <field type="text" subtype="text" label="P.O.Box # " class="form-control text-input" name="text-1655916264509" value="P.O. Box #"></field> <field type="text" subtype="text" label="Postal Code:" class="form-control text-input" name="text-1655916292629" value="Postal Code:"></field> <field type="text" subtype="text" label="Phone No. Residence: " class="form-control text-input" name="text-1655916334437" value="Phone No. Residence:"></field> <field type="text" subtype="text" label="Cell: " class="form-control text-input" name="text-1655916527862" value="Cell:"></field> <field type="text" subtype="text" label="Work:" class="form-control text-input" name="text-1655916606110" value="Work:"></field> <field type="text" subtype="text" label="Fax:" class="form-control text-input" name="text-1655916656253" value="Fax:"></field> <field type="paragraph" subtype="output" label="Please highlight the blocks affected on the map." class="paragraph"></field> <field type="paragraph" subtype="output" label="It is the Applicant's responsibility to call Town Maintenance (306) 736 9092 the preceding day for a confirmation reminder to have the barricades delivered. " class="paragraph"></field> <field type="text" subtype="text" label="Application Date" class="form-control text-input" name="text-1655917130701" value="Application Date"></field> <field type="text" subtype="text" label="Applicant's Name" class="form-control text-input" name="text-1655917336157" value="Applicant's Name "></field> <field type="paragraph" subtype="output" label="Temporary Road Closure Permit Office Use Only" class="paragraph"></field> <field type="textarea" label="Conditions of Approval:" class="form-control text-area" name="textarea-1655917464901" value="Conditions of Approval:"></field> <field type="text" subtype="text" label="Fee:" class="form-control text-input" name="text-1655917505917" value="Fee:"></field> <field type="text" subtype="text" label="Damage Deposit:" class="form-control text-input" name="text-1655917523301" value="Damage Deposit"></field> <field type="text" subtype="text" label="Total:" class="form-control text-input" name="text-1655917543381" value="Total:"></field> <field type="text" subtype="text" label="Date:" class="form-control text-input" name="text-1655917788870" value="Date:"></field> <field type="text" subtype="text" label="Approved By:" class="form-control text-input" name="text-1655917818965" value="Approved By:"></field> <field type="paragraph" subtype="output" label="Copies of Permit to be given to: Ambulance (Fax) 306 736 8407 Applicant (Fax/Email/Mail) R.C.M.P. (Fax) 306 696 5203 Fire Chief Email kdnordal@sasktel.net Town Maintenance (Fax) 306 736 8448" class="paragraph"></field> </fields> </form-template> Submit Submitting...