Conditions and Notes
• Submitting an application for water supply services does not imply approval of the application.
• Any approval granted is subject to the terms and conditions of the Gore District Council Water Bylaw.
It is the applicant’s responsibility to read and understaand the bylaw, which is available on our website
www.goredc.govt.nz, or phone 2090330
• On-site storage equal to a minimum of two days supply shall be installed to properties with restricted
connection to the Council’s water supplies.
• The installation of water connections to points of supply shall be carried out by the Council’s designated
contractor/water supply caretaker or designated representative.
• The supply shall be for the exclusive use of the identiﬁed property and no supply pipe shall cross into or
supply any other peoperty.
• The Council does not guarantee a continuous supply and reserves the right to restrict or impose
restrictions on the use of supply.
• All fees and charges shall be paid prior to any works being carried out following assessment of this
application, please refer to the Council’s fees and charges.
A detailed site plan showing property boundaries, existing water services and the proposed works
must be attached to this application. The application will not be processed without a plan.
The preferred position of the connection, or the location of the connection to be removed/relocated,
together with marked distances/measurements to the nearest boundaries must be shown on the plan.
I, the undersigned, hereby declare that the information given on this application is true and correct. I am authorised
to make this application in the name of the legal owner and in doing so, accept the conditions of supply outlined in
Plan attached: Yes No Date Received:
Application form for new connections, disconnections and additional units 3
Please send your completed form and relevant documents/plans to:
• Email - email@example.com
• Post - Gore District Council, P O Box 8, Gore, 9740
• Deliver - Civic Administration Building, 29 Bowler Avenue, Gore.
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