Township Water Connection

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For Office use: Appl. No______________________ BC No________________________ Val. No ______________________ Applicant Details: Name of Applicant: Postal Address: Phone Number: Email: hereby make application for connection to the: AMBERLEY CULVERDEN HANMER SPRINGS HAWARDEN LEITHFIELD BEACH WAIAU WAIKARI WAIPARA On - Demand Water Supply. (Circle the one that applies) Connection Address: Legal Description: I hereby submit the connection fee (including GST) of: $650.00 for a domestic connection (20mm) plus actual reinstatement costs The connection fee provides for a pipe installation from the main line to the property (up to the first 20 metres inside the road reserve from the point of water supply), a toby box, valve and water. Council advises applicants to install a gate valve on their side of the meter. A Works Order Form will be required with this application if Council staff is required to install additional water lines for distances over 20 metres. These lines may however be installed by the applicant using Council approved pipe & fittings as per the HDC Development Engineering Standards 2017. NB: if the lateral to which this application applies is not within private property and excavation of the Road Reserve is required then a CAR (Corridor Access Request) request along with a traffic management plan must be applied for through a Beforeudig application at www.beforeudig.co.nz By signing below, you agree to comply with all the provisions of the Hurunui District Council Three Waters Bylaw and Three Waters Policy. Applicants Signature Date For Office Use: Receipt Number Date Invoice Number Date Connection made by Date Meter Number Meter Type Meter Location Meter Reading No. of digits Rated by Date Drawn on Plans by Date Updated 01 July 2019 .

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