Application for disconnection of water,
wastewater, or stormwater services
Please read this first
This form will be scanned by electronic equipment. It is
important that you:
use a blue or black pen to mark your answers; and
print clearly.
An estimate will be provided to carry out the disconnection
of service and, upon return of the acceptance form, work
will be programmed.
Once physical works are completed, you will be invoiced
directly by Council at actual cost for each service requiring
disconnection as per the current Tararua District Council
Fees and Charges.
Only Tararua District Council staff are permitted to
work on the water/sewer mains, including water/sewer
If reconnection of services is required at a later date,
the applicant will need to apply for new connections by
completing the necessary forms and paying the required
fee. Forms are available at all Tararua District Council
service centres.
tararua district council
26 gordon street
po box 115
dannevirke 4942
06 374 4080
Applicant details (Please print in CAPITALS)
Title: Mr Mrs Miss Ms
First name of applicant
Surname of applicant
Name of owner
Postal address Postcode
Home phone number Work phone number Mobile phone number
Details of property where work is to be undertaken (Please print in CAPITALS)
House/Rapid number Street/Road name
Town Rate assessment number
Lot/Section number DP number Valuation number
Type of disconnection required
Water Wastewater Stormwater
/ /
2 0
Signature of applicant Date
Office use only
/ /
Application approved by Date
click to sign
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