Expression of Interest - Connection to Southern Wimmera and Northeast Pyrenees Rural Pipeline Feasibility Study

Property Owner or Farming Enterprise *

Contact Person *

Email Address

Phone/Mobile *

Property Address/s *

Postal Address

Type of Use

DomesticStockIntensiveViticultureOther

Benefits Sought

Avoid the cost of maintaining locally harvested water (catchment dams)Maintain viability and sustainability of existing farming, intensive or viticulture operationsImprove productivity, expand or diversify farming, intensive or viticulture operationsOther

If other, please specify

How often do you need to cart water?

Once or more annuallyEvery 2-5 yearsEvery 5+ yearsNever

Expression of Interest

I / We wish to express an interest in connecting to a rural water pipeline systemI / We do not wish to receive any information on a potential non-potable water supply

Additional Comments

Personal information collected will only be used for the purposes permitted under the Privacy and Data Protection Act 2014 (Vic). For further details refer to our Privacy Policy available on our website www.gwmwater.org.au/privacy.

Name

Signature

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Date

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Details of land on which water is to be used

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