Standpipe Access Application Form

Business name

ABN/ACN

Applicant's name

Phone

Address

Street address line 1Street address line 2

City

State

Postcode

Country

Is your postal address the same as this address?

YesNo

Postal address line 1Postal address line 2

City

State

Postcode

Country

Please indicate access term:

Short-term access (8 weeks or less)Long term access

If short term access please indicate end date:

Are you a drinking water carter? (Only drinking water carters can sell water for human consumption.)

YesNo

If yes, a copy of your food licence registration will need to be supplied. Special conditions apply. Please contact GWMWater on 1300 659 961 for more details.

Estimated volume required (Litres)

DayWeekMonth

Electronic standpipe locations:

Elmhurst - Drinking waterArarat - Drinking waterLake Bolac - Drinking waterWickliffe - Non Potable Willaura - Drinking waterMoyston - Non Potable Pomonal - Drinking waterStreatham - Non Potable Norval Dam - Non Potable Westmere - Non Potable Charlton - Non Potable Charlton - Drinking waterDooen - Non Potable Horsham - Drinking waterKorong-vale - Non Potable Ouyen - Non Potable Patchewollock - Non Potable Great Western - Drinking waterStawell - Drinking waterSt Arnaud - Drinking waterLandsborough - Non Potable Kaniva - Non Potable Apsley - Non Potable

Purpose of water usage

Roads/civil worksPotable water carting contractorDirectional drillingDust suppressionFire preventionGeneral farm useStock and domesticVegetationDrinking water (personal use)Weed/pest controlHydro VacOther (please specify below)

I have read and understand GWMWater's Conditions of Use. *

I have read and understand GWMWater's Water Carting Policy. *

I understand an administration fee will occur once this application is approved.
Please refer to gwmwater.org.au/billing/tariffs-and-charges for more information. *

Signature

Draw signature|Type signatureClear

Date

Please wait, files are uploading..