For Office Use: Appl. No_______________________ BC No_________________________ Val. Roll No________________________ Applicant Details: Name of Applicant: Postal Address: Phone Number: Email: Connection to the following reticulated sewer scheme required: AMBERLEY AMBERLEY BEACH CHEVIOT GRETA VALLEY HANMER SPRINGS HAWARDEN LEITHFIELD LEITHFIELD BEACH MOTUNAU BEACH WAIKARI (Circle the one that applies) Connection Address: Legal Description: Tradewaste: Yes / No Connection Fee $100.00 (including GST) An inspection chamber is required to be installed less than one metre inside the property boundary before connection of the sewer drain into the Council lateral. Generally, each property has a lateral from the sewer main to the boundary. However, in the instance where this is not provided, Council will be responsible for the cost of the lateral installation (up to 20m) or where a different connection point is chosen then the full cost of connection to the sewer main will be met by the applicant. This work will be done by a certified drain layer and will require a Building Consent. No work is to start on the sewer connection until building consent approval is obtained 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. 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: _______________________ Updated 01/07/2019 For Office Use: Receipt Number Date Invoice Number Date Connection made by Date Rated by Date Captured on ARC by Date As-builts to Utilities Date Inspected by Date .