Developer Works Application Form

Developer details

First name

Last name

ABN

Address

Street address

Suburb

State

Postcode

Phone number

Email address

Land details

Name of development

Address

Street address

Suburb

State

Postcode

Lot No/s

Plan No/s

CA No/s

Section/s

Parish

Work details

Description of works (tick appropriate boxes)

Urban water main/s

Estimated cost of urban water main/s works (ex. GST)

Rural pipeline/s

Estimated cost of rural pipeline works (ex. GST)

Pressure sewer main/s

Estimated cost of pressure sewer main/s works (ex. GST)

Gravity sewer main/s

Estimated cost of gravity sewer main/s works (ex. GST)

Other (include description in box below)

Estimated cost of other works (ex. GST)

Total estimated cost of works (ex. GST)

Infrastructure design drawings

File upload

Browse

Submissions of infrastructure design drawings can also be emailed to info@gwmwater.org.au. Please quote your applicant details and development address.

Appointment of agent (optional)

I, the Developer, authorise the below Authorised Agent of the below Company to be the authorised agent for the purpose of project management of the developer works and liaise with GWMWater throughout the project timeframes.

*The Authorised Agent does not have the power to issue instructions, sign documents, enter into contracts and agreements, without the consent of the Developer nor undertake and incur GWMWater associated costs on behalf of the Developer.

Agent name

Agent company

Agent address

Street address

Suburb

State

Postcode

Agent phone number

Agent email address

Signature

Signature of developer

Draw signature|Type signatureClear

Date signed