Application for water,
wastewater, or stormwater
connection
Please read this first
This form will be scanned by electronic equipment. It is important that you:
use a blue or black pen to complete this form; and
print clearly.
If your property is outside the urban boundary and you would like to connect to the town water supply, please contact the
Utilities Manager to discuss before lodging this form.
tararua district council
26 gordon street
po box 115
dannevirke 4942
06 374 4080
info@tararuadc.govt.nz
Owner/applicant details (Please print in CAPITALS)
Title: Mr Mrs Miss Ms
First names
Surname
Postal address
Town Postcode
0
-
0
-
Business phone number Mobile phone number
Email
Building/Resource consent numbers
Building consent number Resource consent number
T
TARARUA
ALLIANCE
Office use only – fees payable on application
Application fee: water
$
Application fee: wastewater
$
Application fee: stormwater
$
Total $
Receipt number
Authority register number
Receipt codes for connection fees
Water Wastewater Stormwater
Dannevirke W746.38 W580.38 W703.38
Norsewood W767.38 W599.38 -
Woodville W790.38 W625.38 W712.38
Pahiatua W774.38 W609.38 W709.38
Eketahuna W756.38 W588.38 W705.38
Application approved by
Date
/ /
page 2 of 3 | application for water, wastewater, or stormwater connection | version: 5 | issued: 27 february 2020
Details of property where work is to be undertaken (Please print in CAPS)
Property owner’s name
Street/Rapid number Street/Road name
Town Rate assessment number
/
or
Valuation number Lot/Section number DP number
Description of development
E.g. three townhouses on cross lease title, block of shops, warehouse, etc
Type of connection/installation required
Number of connections required: Water Wastewater Stormwater
Tick one: Residential Industrial/commercial
Water connection
Proposed connection size: 19mm
Water meter required: Yes No
Wastewater connection
Proposed connection size: 100mm Other (specify)
mm
Stormwater connection
Proposed connection size: 100mm 100/150mm (if commercial/industrial)
Type: Kerb Reticulation
Estimated date of connection/installation
/ /
2 0
application for water, wastewater, or stormwater connection | version: 5 | issued: 27 february 2020 | page 3 of 3
As-built plan
On the plan, please provide
a drawing of the proposed
works, including the location
of the connection(s); or
See attached plan
Subject property
Footpath
Road
Scale:
Terms and conditions
An application fee per water, wastewater, or stormwater connection is required to be paid to the Tararua District Council upon
submission of this form.
No contractors are allowed to work on the water/wastewater/stormwater mains in the Tararua District, unless prior approval
is granted.
No work is to commence until an application is submitted and approved.
New connections from the Council main to the boundary of the property are at the applicant’s expense. The nal invoice will be
for the actual costs to complete the work. Council will invoice the applicant once the work has been completed.
Once Council approves the application, the Tararua Alliance will contact the applicant to arrange an estimate. On return of
the acceptance form, the Tararua Alliance will programme the physical works. We endeavour to install the connections within
1015 working days of receipt of acceptance form.
Lodgement of this application does not guarantee the approval of a service connection.
An approved application for supply that has not been actioned within six months of the date of application will lapse unless a
time extension is approved.
I hereby accept the terms and conditions as set out above.
/ /
2 0
Signature of applicant Date
Print name
Office use only – checklist
Application has been completed in full. Application entered in Authority register.
Appropriate application fee(s) have been paid. Application sent to Asset Management.
As-built plan completed showing where utility
connections will be located.
Water meter required.
click to sign
signature
click to edit
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