Engineering Approval Form for a Network Extension - Watercare

Engineering Approval Formfor a Network ExtensionPlease complete this form when applying for approval of a water and/orwastewater extension to Watercare’s network. Attach the relevantengineering plans and supporting documentation, then forward toWatercare for processing.www.watercare.co.nz(09) 442 2222email: info@water.co.nzWatercare Customer Centre,Watercare Services Limited,Private Bag 94010, Auckland 2241Section 1: Applicant DetailsDetails of the person making this application and authorised to pay the fees associated with anetwork extension.First nameLast nameCompany name (if applicable)Postal addressEmailSo that we can get back to you quickly email is thebest and most efficient method for correspondence.Phone ( ) Mobile ( ) Fax ( )PLEASE NOTE: Engineering approval fees must be paid prior to release of the approved plans.These fees will billed to the developer or person nominated in Section 1: Applicant Details.Section 2: Design Engineer DetailsDetails of the engineer responsible for the design of the water and/or wastewaternetwork extension.First nameLast nameChartered Professional Engineer Yes, CPEng number NoCompany name (if applicable)Postal addressEmailSo that we can get back to you quickly email is thebest and most efficient method for correspondence.Phone ( ) Mobile ( ) Fax ( )Section 3: Property DetailsLegal property address (site address)Lot no. DP no. CT no. WardAuckland Council proposal number (if known)WC0027_1011Please turn over and complete other side

Section 4: AuthorisationI, the undersigned, hereby declare that the information given on this application is true and correct.NameSignature Date / /Section 5: Notes1. Missing information may delay processing of this application.2. Full payment of the Watercare Services Limited invoice for engineering compliance fees is required prior to the pre-construction meeting.PrivacyThe information supplied in this application form will be held and used by the staff of Watercare Services Limited. The information will not bedisclosed by Watercare Services Limited unless legally required under the Local Government Official Information and Meetings Act 1987 or forone of the purposes in connection with its collection. The information supplied will be used for: assessing and processing this application andfor administration purposes, updating Watercare Services Limited’s records to ensure all records are accurate, providing Watercare ServicesLimited with statistical information to assist policy development. You have the right to request access to and correction of information collected.For office use only Application number Lodgement date / /Guidelines for completing an Engineering Approval Form for a Network ExtensionThese guidelines are to help you provide the correct information for completing this form so that we can quickly process your application.Section 1: Applicant DetailsYou must provide full name, company phone/mobile/fax number and email address of person responsible for paying the feesassociated with this application. If necessary, use a separate sheet.Section 2: Design Engineer DetailsThe contact details for the design engineer responsible for supervision of the water and/or wastewater network extension andfor signing the completion certificate. Include name, details of engineer certification, company, phone/mobile/fax number andemail address.Section 3: Property DetailsLegal Address of Property requiring engineering compliance – Lot, DP and CT Numbers (i.e. the physical, legal address of thedevelopment). Street address details (must comply with the numbering standards administered by Auckland Council) and the legaldescription (Lot, Deposit Plan and Certificate of Title numbers). These can be found on property plans, building consent or legaldocuments.