Phone: 13 6992 Fax: 1300 862 066 Web: www.taswater.com.au Email: [email protected] Development Services Application 1. Title Address of Development Unit /shop No. Street No. Lot No. Street Suburb Postcode Property Identification (PID) Volume Folio State Postcode Details of work proposed 2. Applicant / Agent Details Applicant / business name Contact person Postal address Suburb Business hours ( phone no. Nature of interest in development Email (certificate to be sent by email) ) Mobile Applicant / agent’s signature Date 3. Property Owner’s Details As per applicant/agent’s details Owner’s name Contact person Postal address Suburb Business hours ( phone no. State ) Postcode Mobile Email Property owner’s signature Development Services Application Date 1 of 3 April 2015 Phone: 13 6992 Fax: 1300 862 066 Web: www.taswater.com.au Email: [email protected] 4. Billing Details Applicant (default) To be sent to Property owner (must completed and signed by the property owner) 5. Development Assessment /Application Type Permit authority (Council) reference number TasWater reference number Please note: A separate application is to be submitted for each stage of your development. Water and/or sewerage service enquiry Building & plumbing exemption application (Refer to statutory declaration page 3) Certificate for certifiable work (building) and/or (plumbing) 56W Consent (for any works located within a TasWater easement or within 2m of TasWater infrastructure) # Certificate of water and sewerage compliance (building) and/or (plumbing) # Engineering design approval # Permit to construct TasWater infrastructure Water and sewerage connections Water meter supply & installation only # Water connection or disconnection # Sewerage connection or disconnection # Fields marked must have the relevant TasWater reference stated to ensure the application can be accepted. 6. Lodgement of Application Applications may be submitted in person at any TasWater office or via:: Email (preferred): [email protected] Mail: Development Services GPO Box 1393 Hobart TAS 7001 7. Documents required when lodging this Application Completed trade waste application form (if applicable) Full copy of certificate of title documents Planning permit (if applicable) Any additional documents or information that may assist assessment Detailed plans of the proposed development / works showing existing and proposed TasWater assets, including connections 8. Privacy Statement TasWater collects personal information for the purposes of providing water and sewer related services and products, promoting such services and market research. We may disclose your personal information to our contractors for these purposes and other third parties including local Councils, the Tasmanian State Government or its officers. You may request access to your personal information that we hold by writing to the Privacy Officer at TasWater Service Centre. Please note we may charge a reasonable cost of providing you with access to your personal information. 2 of 3 Phone: 13 6992 Fax: 1300 862 066 Web: www.taswater.com.au Email: [email protected] Statutory Declaration for Exemption Application If answering ‘YES’ to ANY of the questions a Certificate for Certifiable Work (Building) and/or (Plumbing) is required. If ‘NO’ to ALL questions, development is exempted. This form must be certified by an authorised TasWater assessment officer to be valid. Questions Yes No Are new structures 2m or less from TasWater underground services including eaves overhanging into that distance? Is the development non-residential, commercial or industrial or 2 another process that generates Trade Waste to sewer? Is the development non-residential, commercial or industrial or 3 another process that has or will require a connection to the reticulated water supply? Does the development increase the demand for water or 4 sewerage services or require an increase in connection size Is the development within a water supply catchment or effect 5 water quantity or quality, i.e. dams, mining, subdivisions with septic systems, dairies, plantations? Is the development within a declared TasWater buffer zone, 6 i.e. near a sewerage treatment plant or water treatment plant? Are any utilities or services being proposed to cross TasWater 7 water or sewerage infrastructure? Is the application a subdivision of land, a strata title or a 8 consolidation of titles? Does the proposal require a new water or sewer connection 9 i.e. no current services on the lot? Is demolition of a structure or disconnection from TasWater 10 Mains infrastructure involved? Statutory Declaration 1 In signing the statutory declaration against the requirements of the Water and Sewerage Industry Act 2008, I declare that all questions have been answered truthfully. I make this solemn declaration under the Oaths Act 2001. Applicant / agent’s signature Date Name TasWater Approval Certifying officer: Date: Only valid upon completion by an authorised officer Development address Suburb Postcode Details of proposed work 3 of 3
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