Application for Connection to Services - Ōtorohanga Community – Doc ID: 275666
APPLICATION FOR
CONNECTION TO SERVICES
ŌTOROHANGA COMMUNITY
Applicants Name: Date:
Property Address:
Postal Address:
Telephone: Cellphone:
Service connection requirements:
Charges are per connection required NOT per application Size of property – standard/large
Water Supply Connection: Number: Size:
Storm Water Connection: Number: Size:
Sewer Connection: Number: Size:
Residential Commercial
Other: (Please specify)
Description of development:
(eg 3 townhouses on cross lease title, block of shops, warehouse, etc)
Is the property already supplied with water? Yes No
Were any buildings demolished to which water was supplied? Yes No
Connection installation required by: / / Date for connection
I/we hereby acknowledge that the information contained in this application is true and correct.
Signed by owner / on behalf:
Please show on the reverse page:
SCALE DIAGRAM FOR METER / CONNECTION LOCATION
(Show distances from boundaries, entranceways, power poles, etc)
Office: Connection Charges:
Application received by: No: @ $ =
Valuation number: No: @ $ =
Legal description: No: @ $ =
Receipt No: Total fee / Advance Payments: =
