Form 1 Application under section 10 of the Water Act 1912 for a licence
(Clause 6)
Application No
| Surname | Other Names | Please use block letters |
| Postal Address | |
| Name of river, creek, watercourse, billabong, lake, lagoon etc | | |
| Means of taking water, eg gravitation, pumping etc | | |
| Particulars of works to be licensed | Site of works to be licensed |
| Portion No | Parish | County |
| State whether pump, dam, race, levee, cutting etc | | | | |
| What right of occupation of this site do you hold | |
| Details of area, if any, to be irrigated by this work | Area | Portion No | Parish | County |
| Type of Crop |
| | hectares | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| Size and type of pump or size of diversion pipe or channel etc | |
| Maximum rate at which water may be taken by means of the works (litres/second) | |
| Estimated quantity of water proposed to be taken annually (megalitres) | |
| Purpose of Works | Purpose for which water is to be used |
| □ Water Conservation | □ Drainage | Water Supply for— | |
| □ Irrigation | □ Prevention of inundation | □ Irrigation | □ Mining | □ Domestic |
| □ Water Supply | | □ Stock | □ Industrial |
| | □ Changing the course of a river | If for any other purpose give details— |
| (tick appropriate square) |
| If water to be used for irrigation state—Type of works to be provided for distribution of water, eg pipes, earthen channels, spray plant etcWorks proposed to be undertaken in preparation of land for irrigation, eg grading, check-banking | |
| Name/s of local newspaper/s circulating in the district | |
Names of any other landholders to be supplied with water, the location of their lands to be supplied and the purpose for which water will be used—
I, of
apply for a licence to construct and use the works described and to take, use and dispose of the water, if any, conserved or obtained for the purpose specified in this application and attach—
(a) a PLAN showing the boundaries of the land occupied by me, the site of the work to be licensed, the land, if any, to be irrigated and the boundaries of the land of any other person to be supplied with water, and
(b) a deposit of $ as security for the cost of investigation and inquiry in connection with the application.
Schedule Schedule 3 - Water (Part 2—General) Regulation 1997 - Forms | Zoe
Dated this day of 19
| | .........................(Signature of Applicant) |
Form 2 Application under section 13A of the Water Act 1912 for a licence
(Clause 6)
Application No
| Surname | Other Names | Please use block letters |
| Postal Address | |
| Name of river, creek, watercourse, billabong, lake, lagoon etc | | |
| Means of taking water, eg gravitation, pumping etc | | |
| Description of SUPPLY WORKS—state whether dam, pump, levee etc | | |
| Type and size of pump or size of diversion pipe or channel etc | | |
Location and extent of lands on which SUPPLY WORKS are to be constructed
| Portion No | Parish | County | Area | Name and address of OWNER | Name and address of OCCUPIER |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| Particulars, giving sizes, capacities and grades of any channel, flume, pipe, conduit of other work in which water is to be conveyed from the supply work to the land to be supplied with water (longitudinal and cross-sectional plans of any channel to be attached) | |
Location and extent of lands on which CONVEYING WORKS are to be constructed
| Portion No | Parish | County | Area | Name and address of OWNER | Name and address of OCCUPIER |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| Maximum rate at which water may be taken by means of the supply work (litres/second) | | | |
| Estimated quantity of water proposed to be taken annually (megalitres) | | | |
| Purpose for which water is to be used | Water Supply for— |
| | □ Irrigation | □ Stock | □ Domestic |
| (tick appropriate square) |
Details of APPLICANT’S LAND to which water is to be supplied
| Portion No | Parish | County | Nature of applicant’s tenure of this land |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
Details of APPLICANT’S LAND, if any, which is to be irrigated by these works
| Type of Crop | Area | Portion No | Parish | County |
| | hectares | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| If water to be used for irrigation state—Type of works to be provided for distribution of water, eg pipes, earthen channels, spray plant etcWorks proposed to be undertaken in preparation of land for irrigation, eg grading, check-banking | |
| Name/s of local newspaper/s circulating in the district | |
I, of
the occupier of the land firstly described, wishing to construct and use the supply work and conveying works described for the purpose mentioned, and being unable to obtain occupation of the whole of the land required for the works, apply for a licence to construct the supply work and to take and use for the purpose the water obtained.
I attach a plan showing—
(a) the location of the land to be supplied with water in relation to the river, creek, watercourse, billabong, lake, lagoon etc, from which the water supply is to be obtained and the portion of that land which I propose to irrigate, and
(b) the location of the land on which the supply work and the conveying works are proposed to be constructed, and
(c) the positions of the proposed supply work and conveying works.
I also attach plans showing longitudinal and cross-sections of all channels proposed to be constructed to convey water from the supply work to the land to be supplied with water.
I enclose a deposit of $ as security for the cost of investigation and inquiry in connection with the application.
Dated this day of 19
| | .........................(Signature of Applicant) |
Form 3 Application under Part 2 of the Water Act 1912 for a permit
(Clause 6)
Application No
| Surname | Other Names | Please Use Block Letters |
| | Postal Address |
| Name of river, creek, watercourse, billabong, lake, lagoon etc | | |
| Means of taking water, eg gravitation, pumping etc | | |
Details of works for which permit is required
| Particulars of Works | Portion No | Parish | County |
| State whether pump, dam, race, levee, cutting etc | | | | |
| What right of occupation of the site of the proposed works do you hold? | |
Details of area, if any, to be irrigated—MAXIMUM AREA ALLOWED 4 HECTARES
| Type of Crop | Area | Portion No | Parish | County |
| | hectares | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| Size and type of pump or size of diversion pipe or channel etc | |
| Purpose of Works | Purpose for which water is to be used |
| □ Water Conservation | □ Drainage | Water Supply for— |
| □ Irrigation | □ Prevention of inundation | □ Irrigation | □ Mining | □ Domestic |
| □ Water Supply | | □ Stock | □ Industrial |
| | □ Changing the course of a river | If for any other purpose give details— |
| (tick appropriate square) |
| Period for which permit is required | □ 3 months | □ 9 months |
| | □ 6 months | □ 12 months |
| (tick appropriate square) |
I, of ,
being the owner or occupier of the land described, apply for a PERMIT to construct and use the works described and to take and dispose of the water obtained for the purpose specified. I attach a PLAN showing the boundaries of the land owned or occupied by me, the site of the work for which a permit is required and the land, if any, to be irrigated.
Dated this day of 19
| | .........................(Signature of Applicant) |
Form 4 Application under section 20 of the Water Act 1912 for an authority for a joint water supply scheme
(Clause 6)
Application No
| Surnames | Other Names | Postal Addresses | Please Use Block Letters |
| Name of person and postal address to which correspondence and Water Diversion Returns are to be sent | |
| Name of river, creek, watercourse, billabong, lake, lagoon etc | |
| Means of taking water, eg gravitation, pumping etc | |
Details of land of each occupier to be supplied with water
| Particulars of Works | Portion No | Parish | County | Maximum rate at which water may be taken |
| State whether pump, dam, race, levee, cutting etc | | | | | litres/second |
| Type and size of pump or size of diversion pipe or channel etc | | | | |
| Particulars, giving sizes, capacities and grades of any channel, flume, pipe, conduit or other work in which water is to be conveyed to the land of each occupier (longitudinal and cross-sectional plans of any channel to be attached) | | | | |
| Purpose for which water is to be used | Water Supply for— |
| (tick appropriate square) | □ Irrigation | □ Mining | □ Domestic |
| | □ Stock | □ Industrial | |
| | If for any other purpose give details— |
Details of crops, if any, to be irrigated by each occupier
| Occupier | Type of crop | Area | Total area to be irrigated by each occupier |
| | | hectares | hectares |
| | | | |
| | | | |
| | | | |
| | | Total area to be irrigated by all applicants— |
| | | | hectares |
| Estimated quantity of water proposed to be taken annually (megalitres) | |
| Occupier | Estimated quantity of water proposed to be delivered annually | Particulars of rates and times at which water is proposed to be delivered to each occupier | Particulars of any other matters affecting the apportionment of water between the several occupiers |
| | megalitres | | |
| | | | |
| | | | |
| | | | |
| | | | |
| Particulars of any money paid or proposed to be paid to any person in respect of the supply of water in connection with the joint water supply scheme | |
| Particulars of any money paid or proposed to be paid to any person in respect of the occupancy or transfer of any land because of or in connection with the joint water supply scheme | |
Particulars of the arrangements between the applicants in respect of—
| The provision and construction of the works | |
| The operation of the works | |
| The maintenance and renewal of the works | |
| The provision of money for each of the foregoing | |
| The payments to be made by any of the occupiers in respect of the foregoing | |
| Name/s of local newspaper/s circulating in the district | |
We,
being the occupiers of the lands detailed, apply for an authority under Part 2 of the Water Act 1912 to construct and use the joint water supply scheme described and to take and use the water conserved or obtained for the purposes specified.
We attach a plan showing—
(a) the land occupied by each occupier,
(b) the location of the means by which water is to be taken from the river, creek, watercourse, billabong, lake, lagoon etc,
(c) the location of any channel, flume, pipe, conduit or other work in which water is to be conveyed,
(d) the location of any bridge, culvert, syphon, check, regulator or other structure or work to be provided,
(e) if the work is for the purpose of irrigation the location of the areas proposed to be irrigated within the land of each occupier.
We also attach longitudinal and cross-sectional plans of all channels proposed to be constructed for the conveyance of water to the land of each occupier.
We also attach a certified copy of any agreement entered into between the occupiers or between the occupiers and any other person in respect of the joint water supply scheme.
We enclose a deposit of $ as security for the cost of investigation and inquiry in connection with the application.
Dated this day of 19
| | ......................... |
| | ......................... |
| | .........................(Signatures of all Applicants) |
Form 5 Application under section 20CA of the Water Act 1912 for an authority for a joint water supply scheme
(Clause 6)
Application No
| Surnames | Other Names | Postal Addresses | Please Use Block Letters |
| Name of person and postal address to which correspondence and Water Diversion Returns are to be sent | | |
| Name of river, creek, watercourse, billabong, lake, lagoon etc | |
| Means by which water is to be taken, eg gravitation, pumping etc | |
Details of land of each occupier to be supplied with water
| Particulars of Works | Portion No | Parish | County | Maximum rate at which water may be taken |
| State whether pump, dam, race, levee, cutting etc | | | | | litres/second |
| Type and size of pump or size of diversion pipe or channel etc | | | | |
| Particulars, giving sizes, capacities and grades of any channel, flume, pipe, conduit or other work in which water is to be conveyed to the land of each occupier (longitudinal and cross-sectional plans of any channel to be attached) | | | | |
| Purpose for which water is to be used | Water Supply for— |
| (tick appropriate square) | □ Irrigation | □ Stock | □ Domestic |
Location and extent of lands not occupied by applicants—
On which Supply Work is to be constructed—
| Portion No | Parish | County | Area | Name and Address of owner | Name and Address of occupier |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
On which Conveyancing Works are to be constructed—
| Portion No | Parish | County | Area | Name and Address of owner | Name and Address of occupier |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
Details of Crops, if any, to be irrigated by each occupier—
| Occupier | Type of crop | Area | Total area to be irrigated by each occupier |
| | | hectares | hectares |
| | | Total area to be irrigated by all applicants |
| | | | hectares |
| Estimated quantity of water proposed to be taken annually (megalitres) | |
| Occupier | Estimated quantity of water proposed to be delivered annually | Particulars of rates and times at which water is proposed to be delivered to each occupier | Particulars to any other matters affecting the apportionment of water between the several occupiers |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| Particulars of any money paid or proposed to be paid to any person in respect of the supply of water in connection with the joint water supply scheme | |
| Particulars of any money paid or proposed to be paid to any person in respect of the occupancy or transfer of any land because of or in connection with the joint water supply scheme | |
Particulars of the arrangements between the applicants in respect of—
| The provision and construction of the works | |
| The operation of the works | |
| The maintenance and renewal of the works | |
| The provision of money for each of the foregoing | |
| The payments to be made by any of the occupiers in respect of the foregoing | |
| Name/s of local newspaper/s circulating in the district | |
We,
the occupiers of the lands firstly described, wishing to construct and use the supply work and conveying works described for the purpose mentioned, and being unable to obtain occupation of the whole of the land required for the works, apply for an authority for a joint water supply scheme to construct the supply work and to take and use for the purpose the water obtained.
We attach a plan showing—
(a) the land occupied by each occupier,
(b) the location of the land to be supplied with water in relation to the river, creek, watercourse, billabong, lake, lagoon etc, from which the water supply is to be obtained,
(c) the land on which the supply work and the conveying works are proposed to be constructed,
(d) the location of the proposed supply work and conveying works,
(e) the location of the means by which water is to be taken from the river or lake and the location of any channel, flume, pipe, conduit or other work in which water is to be conveyed to the land of each occupier,
(f) the location of any bridge, culvert, syphon, check, regulator or other structure or work to be provided,
(g) if the work is for the purpose of irrigation, the location of the areas proposed to be irrigated within the land of each occupier.
We also attach longitudinal and cross-sectional plans of all channels proposed to be constructed for the conveyance of water to the land of each occupier.
We also attach a certified copy of any agreement entered into between the occupiers or between the occupiers and any other person in respect of the joint water supply scheme.
We enclose a deposit of $ as security for the cost of investigation and inquiry in connection with the application.
Dated this day of 19
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| | ......................... |
| | .........................(Signatures of all Applicants) |
Form 6 Application under section 20K of the Water Act 1912 for a group licence
(Clause 6)
Application No
| Please use block letters | Name of Applicant | |
| Postal Address | |
| Name of river, creek, watercourse, billabong, lake, lagoon etc | |
| Means by which water is to be taken—eg gravitation, pumping etc | |
Details of land of each occupier to be supplied with water
| Particulars of works | Portion No | Parish | County | Maximum rate at which water may be taken |
| State whether pump, dam race, cutting etc | | | | | |
| Type and size of pump or size of diversion pipe or channel etc | | | | |
| Particulars, giving sizes, capacities and grades of any channel, flume, pipe, conduit or other work in which water is to be conveyed to the land of each occupier (longitudinal and cross-sectional plans of any channel to be attached) | | | | |
| Purpose for which water is to be used | Water Supply for— |
| □ Irrigation | □ Stock | □ Domestic |
| (tick appropriate square) | | | |
Details of crops, if any, to be irrigated by each occupier
| Occupier | Type of crop | Area (hectares) | Total area to be irrigated by each occupier (hectares) |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| Total area to be irrigated by all occupiers | |
| Estimated quantity of water proposed to be taken (litres/second) annually (megalitres) | |
| Occupier | Estimated quantity of water proposed to be delivered annually | Particulars of rates and times at which water is proposed to be delivered to each occupier | Particulars of any other matters affecting the apportionment of water between the several occupiers |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| Name/s of local newspaper/s circulating in the district | | | |
I,
apply for a group licence under Part 2 of the Water Act 1912 to construct and use or to use the work described and to take the water conserved or obtained and dispose of it for the use of the occupiers from time to time of land within the private district of the Board for the purposes specified in this application.
Attached is a plan showing—
(a) the land occupied by each occupier,
(b) the location of the means by which water is to be taken from the river, creek, watercourse, billabong, lake, lagoon etc,
(c) the location of any channel, flume, pipe, conduit or other work in which water is to be conveyed,
(d) the location of any bridge, culvert, syphon, check, regulator or other structure or work to be provided,
(e) the location of the areas proposed to be irrigated within the land of each occupier.
Also attached are longitudinal and cross-sectional plans of all channels proposed to be constructed for the conveyance of water to the land of each occupier.
Enclosed is a deposit of $ as security for the cost of investigation and inquiry in connection with the application.
Dated this day of 19
| | .........................(Signature of Applicant) |
Form 7 Application under section 20Q of the Water Act 1912 for an amended group licence
(Clause 6)
Application No
| Please use block letters | Name of present holder of group licence | Number of existing group licence— |
| Postal Address | |
Names and addresses of all occupiers of ADDITIONAL LANDS proposed to be supplied with water
| Surnames | Other names | Postal Addresses |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| Purpose for which water is to be used on the ADDITIONAL LANDS | Water Supply for— |
| □ Irrigation | □ Stock | □ Domestic |
| (tick appropriate square) | | | |
Details of land of each ADDITIONAL OCCUPIER to be supplied with water
Details of crops, if any, to be irrigated by each ADDITIONAL OCCUPIER
| Occupier | Type of crop | Area (hectares) | Total area to be irrigated by each occupier (hectares) |
| | | | |
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| | | | |
| | | | |
| | | | |
| | | | |
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| | | | |
| | | | |
| Total area to be irrigated by all additional occupiers | | |
Details of proposed alteration of licensed works
| Particulars of proposed alteration of works | Portion No | Parish | County | Maximum rate at which water is proposed to be taken (litres/second) |
| State whether change in or addition to existing works | | | | | |
| Particulars, giving sizes, capacities and grade of any channel, flume, pipe, conduit or other work in which water is proposed to be conveyed to the additional land (megalitres) (longitudinal and cross-sectional plans of any channel to be attached) | |
| Estimated quantity of water proposed to be delivered annually to the additional land | |
| Particulars of the rates and times at which water is proposed to be delivered to the additional land | |
| Name/s of local newspaper/s circulating in the district | |
I,
apply for an amended group licence under Part 2 of the Water Act 1912 to construct and use or to use the work described and to take the water conserved or obtained and dispose of it for the use of the occupiers from time to time of land within the private district of the Board for the purposes specified.
Attached is a plan showing—
(a) the additional land proposed to be included in the amended group licence and its relation to the land specified in the existing group licence,
(b) the location of any channel, flume, pipe, conduit or other work by means by which water is proposed to be conveyed to the additional land,
(c) the location of any additional bridge, culvert, syphon, check, regulator or other structure or work proposed to be conveyed to the additional land,
(d) the location of the area proposed to be irrigated within the additional land.
Also attached are longitudinal and cross-sectional plans of all channels proposed to be constructed for the conveyance of water to the additional land.
Dated this day of 19
| | .........................(Signature of Applicant) |
| River or Lake | |
| Portion | |
| Parish | |
| County | |
| Nature and description | |
| Purpose | |
Details of Land to be Irrigated
| Portion | |
| Parish | |
| County | |
| Area to be irrigated | hectares | Period for which licence issued | years | Fee | $ |
The work described, and referred to in the application and plans deposited by or on behalf of the licensee, as finally approved by the Water Administration Ministerial Corporation, is declared to be a licensed work under the Water Act 1912.
This licence is subject to the terms, limitations and conditions set out on the attached Condition Statement.
| River or Lake | |
| Portion | |
| Parish | |
| County | |
| Nature and description | |
| Purpose | |
Details of Conveyancing Works (plan attached)
| Portion | |
| Parish | |
| County | |
| Nature and description | |
| Area to be irrigated | hectares | Period for which licence issued | years | Fee | $ |
The work described, and referred to in the application and plans deposited by or on behalf of the licensee, as finally approved by the Water Administration Ministerial Corporation, is declared to be a licensed work under the Water Act 1912.
This licence is subject to the terms, limitations and conditions set out on the attached Condition Statement.