Services Connection Application Form - Hunter Water

APPLICATION FOR SERVICES CONNECTION
Hunter Water Corporation
ABN 46 228 513 446
Customer Enquiries 1300 657 657
services.applications@hunterwater.com.au
PO Box 5171
HRMC NSW 2310
36 Honeysuckle Drive
Newcastle NSW 2300
OWNER NAME
APPLICANT
ADDRESS
4YOU MUST COMPLETE THESE FIELDS - PLEASE PRINT CLEARLY IN CAPITAL LETTERS
APPLICANT/OWNER DETAILS
4
4
4
This is a permit for the purposes of the HWC (General) Regulation 2005
OFFICE USE ONLY
ACCOUNT NO (PERMIT):
DEVELOPER FILE REFERENCE NO:
CONTACT NAME
PHONE NO
EMAIL
4
4
BUS
FAX 4
MOB
4
POSTCODE
4
SEWER CONNECTIONS
COMMON EFFLUENT PUMP - AGREEMENT REQUIRED
NON-STANDARD CONNECTION
JUNCTION INFO ISSUED BY MAIL / FAX / IN-PERSON
WATER CONNECTION
PRE-LAID SERVICE
DESCRIPTION OF LAND
LOT/SEC/DP NO
4
HOUSE NO
SUBURB
4 STREET 4
4
PREMISE TYPE
4
eg VACANT LAND / INDUSTRIAL / STAND-ALONE DWELLING
PROPOSED PROPERTY DEVELOPMENT
4
RESIDENTIAL: NEW EXISTING
4 NON-RESIDENTIAL: NEW EXISTING
Rainwater Tanks
4
Above BELOW NOT APPLICABLE
DETAILS OF PLUMBING CONTRACTOR
PLUMBER #1 4NAME: LIC: TEL:
WATER SEWER
PLUMBER #2 NAME: LIC: TEL: WATER SEWER
COMMENTS
HUNTER WATER CORPORATION SERVICES CONNECTION APPLICATION TYPE
INSPECTION SELECTIONS & DETAILS
INSPECTIONS TO BE BOOKED WITH - NSW FAIR TRADING
YES P
FEE
CONNECTION TO SEWER NOMINATE LOCAL COUNCIL'S APPROVAL NO:
$
CONNECTION TO RECYCLED WATER METER AFFIXTURE: $
INSPECTIONS TO BE BOOKED WITH - HUNTER WATER
YES P
DATE
FEE
CONNECTION TO WATER NOMINATE METER SIZE:
....... /....... /....... $
WATER METER AFFIXTURE METER FRAME READY DATE:
....... /....... /....... $
RECYCLED WATER METER AFFIXTURE METER FRAME READY DATE:
....... /....... /....... $
WATERMAIN DRILLING MAIN size: Main type: TIME: HWC: YES NO
....... /....... /.......
$
DISCONNECTION TO WATER returned meter NO:
READING:
....... /....... /....... $
DISCONNECTION TO SEWER ....... /....... /....... $
APPLICANT
SIGNATURE
DATE
/ /
TOTAL
$
OFFICE USE ONLY5
POST TO: HUNTER WATER, CUSTOMER SERVICES GROUP, PO BOX 5171 HRMC 2310
ENQUIRIES: 1300 657 657 PAYMENTS: see details on other side

PAYMENT OPTIONS
CASH, CHEQUE OR CREDIT CARD (MAX $10,000) payment iN PERSON
NEWCASTLE CUSTOMER CENTRE . 36 HONEYSUCKLE DRIVE . NEWCASTLE
MAITLAND CUSTOMER CENTRE . 285 HIGH STREET . INSIDE MCC COUNCIL OFFICE
LAKE MACQUARIE CUSTOMER CENTRE . 126 MAIN ROAD . INSIDE LMCC COUNCIL OFFICE
CHEQUE by mail
HUNTER WATER CORPORATION . CUSTOMER SERVICES GROUP . PO BOX 5171 . HRMC NSW 2310
CREDIT CARD - MAX AMOUNT $10,000
BY MAIL: COMPLETE CREDIT CARD AUTHORITY BELOW AND MAIL TO: HUNTER WATER CORPORATION . CUSTOMER SERVICES GROUP . PO BOX 5171 . HRMC NSW 2310
CREDIT CARD PAYMENT AUTHORITY
CARD NO
MASTERCARD BANKCARD VISA
VALID TO
/
NAME ON CARD CVC NUMBER LAST 3 DIGITS ON THE BACK OF CARD
SIGNATURE
TOTAL AMOUNT $
PROCESSING OF THIS APPLICATION MAY BE DELAYED IF ALL RELEVANT INFORMATION IS NOT PROVIDED
This permit is issued under the following conditions:
1 The permit is approved only after payment of required fees and charges.
2 The customer allows an officer of the Corporation to enter the property for the purpose of inspecting the plumbing work
performed pursuant to this permit.
REFER TO OUR SERVICES CONNECTION POLICY AT WWW.HUNTERWATER.COM.AU