Stockwater Race Works Consent
Application Form
Please return this form to: info@adc.govt.nz or Ashburton District Council, PO Box 94, Ashburton 7740
Applicant(s) Details
Applicant 1 Name:
Applicant 2 Name:
Company Name:
Postal Address:
Physical Address:
Contact Person:
Business number:
Job Title:
Mobile number:
Email address:
Home number:
Location of Works
Site Address:
Legal Description of Property:
Property Number:
Type of Consent
Add a pipe or pump service
Construction of soak hole
Extension of existing race
Pond Service
Closure of existing race
Construction of new culvert/crossing
Deviation of existing race
Construction of new race
Description of Works
Please describe fully the proposed works for which consent is being sought:
Site Plan of the Proposed Works
Please attach a plan showing the proposed works. The plan should show the entirety of the proposed works and
specifically include the following information and be clearly labelled.
Location of existing races
Dimensions (length, width, depth, grade) of
existing races
Location of proposed races
Direction of flow
Discharge points
Property boundaries
Road names
Fence lines
Locations of structures (culverts, weirs or
junctions) on the races
Specifications of proposed work - ie, culvert
materials and diameters
Indication of due north
Assessment of Effects of the Proposed Works
Please complete a “Stockwater Race Works - Assessment of Effects” form (Form 2) for the following water race works
deviation of existing race, extension of existing race, closure of existing race and construction of a new race. You do
not need to complete an assessment of effects form for water race service applications.
Approval from Affected Parties
Please include a signed consent form (Form 3) completed by each of the parties who may be affected by the
proposed works. Note: An Affected party is anyone who may be affected by the proposed works both in the short
term (ie while the works are being carried out) and in the long term (once the works are completed).
Signature and Date
Signed: _____________________________ Date: _________________________________
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signature
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