QES Management System

Issue Date: 30/06/2017

Single Residential Application

City West Water

Address Locked Bag 350, Sunshine 3020 Phone 1300 299 228

Email Web www.citywestwater.com.au


Application to carry out plumbing work for sewerage, drinking water and recycled water in a single residential building

NOTE: Please allow a minimum of 10 (ten) working days for the completion of this application. Insufficient information may cause delays.

Office Use Only
Property service number:: / SPA: /
Additional info:

Property details

Lot number: / Plan of subdivision: / Street number: / Street name:
Suburb: / Postcode:

Is your property on a combined drain? Yes No

Applicant details (all fields mandatory)

Applicant’s name:
Company name (if applicable):
Postal address:
Postcode:
Phone: / Mobile:
Email:


Plumber’s details (all fields mandatory)
Below ground plumbing

Drainer’s name : / Phone number: / Licence number:

Drinking water connection

Plumber’s name : / Phone number: / Licence number:
Recycled water connection (if applicable)
Plumber’s name: / Phone Number: / Licence number:
(mandatory field)
Who is responsible for constructing the driveway? Owner Builder
AND brief description of works to be undertaken:

List of works to be carried out

Application fee (mandatory and non-refundable)
AND / $85.35
New house – new connection for potable water and sewer connection (dry tapping service area)
OR / $479.50
New house – new connection for potable water, sewer and recycled water connection (dry tapping service area)(includes 3 x inspections)
OR / $1190.90
New or existing house for potable water and sewer connection (wet tapping service area)
Note: All excavation, backfilling, council permits and traffic management to be organised by City West Water for wet tapping connections.
OR / POA
Demolition and rebuild, including replacement of a water meter
OR / $187.70
House extension
OR / Application Fee
Assess and design for new sewer connection only
OR / $102.85
Below ground sewer works for alteration/renovation/disconnection
OR / Application Fee
Water consent only – plugging and/or re-tapping
Note: All excavation, backfilling, council permits and traffic management to be organised by City West Water for wet tapping connections. / POA
TOTAL FEE TO BE PAID / $

Important notice for recycled water customers

Recycled water plumbing inspections to be carried out at the following stages: 1. Meter to dwelling; 2. Rough in; 3. Commissioning. The plumber nominated on this application is responsible for contacting City West Water’s contractor, CIS Services, 1800 627 173 or to schedule inspections. One working day’s notice is required.

I acknowledge that I have read and accept the requirements for connecting to recycled water

I acknowledge that the licensed plumber nominated on the application must install a recycled water washing machine stop tap.


By signing this application form I do so as the owner (or authorised by the owner to make this application). I will therefore be responsible to meet all City West Water’s requirements including ensuring the security of the water meter(s) and will obtain all appropriate permits prior to any works commencing. I also acknowledge that should/when a meter(s) be/is installed as a result of this application then appropriate service charges will apply.

Privacy Statement

The personal information requested on this form is being collected by City West Water for the purpose of preparing a single residential application or any other directly related purpose. It will not be disclosed to any other external party without your consent unless required or authorised by law. If you wish to alter any of the personal information you have supplied to City West Water, please contact .

Signed: / Date:

Checklist

I have attached/completed the following so as to ensure no delays in processing my application:

A copy of a final or an approved stamped site plan (see below for site plan requirements)

Preliminary or draft copies are not acceptable.

A clear description of works

ALL plumber details including licence number

ALL owner details

Credit card/cheque payment details

Once completed, please send all documentation to: OR
Locked Bag 350, Sunshine 3020.

Application will only be assessed if the following details are shown on the
proposed plan:

·  The property address

·  All title boundaries

·  Offset from property boundary to all proposed structures including sheds, pools, etc.

·  Offset from property boundary to dwelling (marked in blue below)

·  Driveway and pathway details including the offset and the width

·  All paved areas

·  Rainwater tanks

Example of site plan required:


Cheque Money order Credit card Total: $
Credit card details – PLEASE USE BLOCK LETTERS
Title: Mr Mrs Ms Miss Other
Cardholder’s Name:
Address: / Postcode:
Card Type: Visa Mastercard
Card Number: / Expiry date:

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