Schedule 1 Forms

Schedule 1 Forms

Form 1

(Clause 4)

APPLICATION FOR A BORE LICENCE UNDER PART 5 OF THE WATER ACT 1912

(Section 113, Water Act 1912)

SECTION 1

Applicant(s)—

Surname: .........................First Names: ............................................................

Surname: .........................First Names: ............................................................

Postal Address: ............................................................

.................... Post Code: .......... Telephone: ............................................................

Property Address: ............................................................

.................... Post Code: .......... Telephone: ............................................................

| Location of work to be licensed | Portion/Lot/DP | Parish | County | | | | | | Nature of work to be licensed | □ Proposed | □ Alteration | Proposed depth in metres | □ Existing | | Is work to replace an abandoned work? | Is work to be altered already licensed? | Is application replacing an existing licence? | | □ Yes □ No | □ Yes □ No | □ Yes □ No | | Details | | | Type of work | □ Bore | □ Well | □ Excavation | | □ Spearpoints(s) | □ Artesian bore | □ Test bore | | Ultimate purpose for which water is to be used from the completed or converted work | □ Stock | □ Waste disposal | □ Irrigation | □ Sand and gravel washing | Estimated annual usage in megalitres | | □ Domestic | | □ Town water | | | □ Farming (Not irrigation) | □ Drainage | □ Recreation | □ Industrial/ commercial | | | | | | | □ Mining | | | If application purpose is for town water, please provide in a separate sheet details of ALL existing town water bores and wells including: Bore No., Licence No., annual allocation and usage in megalitres. | | Complete if other landholders to be supplied with water | Name | Portion/ Lot/DP | Parish | County | Purpose of supply | | | | | | |

SECTION 2 (complete this section if the application includes irrigation)

| Description of property (from your rate notice or local Council) | Portion/ Lot/DP | Parish | County | Total area in hectares | Is the property leased? | | | | | | □ Yes □ No | | Details of crops to be irrigated | □ Orchard | □ Vines | □ Other | Area in hectares | | Any other irrigation from bores and wells | Number of bores and wells | Type of crop(s) | Area in hectares | | Any other irrigation | From rivers, lakes etc | Area authorised | From Ministerial Corporation channels | Area authorised | | □ Yes □ No | | □ Yes □ No | | | Details | | |