Page 1 of 2Certificate application - Water Services division - V4 - July 2020

Certificate application Water Services division

Applicant details

Lot/Portion Section DP/SP

House/unit number Street

Town Postcode

Name

Address

Telephone number Mobile number

Email address

Notes

Land IDProperty ID

Office use only

Entered by Date

Subdivider

Owner/s address

Nature of property (eg vacant land, house, unit)

Receipt numberDate paidFee paid

Certificate requiredWater and sewer - fees and charges (Section 603 LGA 1993)

Special meter reading

Drainage diagram

Does not include special meter reading

In addition to Section 603

Fee (1 July 2020 to 30

June 2021)

$0*

$81

$73

An urgency fee of $80 for drainage diagram requests if required within 24 hoursPlease note Section 603 certificate fees paid to MidCoast Council also provides a Section 603 certificate, at no additional cost, from the Water Services division. A separate application must still be undertaken with Water Services division.

Reference/Contact name

Property details

Owner/s details

Owner/s name

New subdivision (where lot is part of a recent subdivision, details of land before subdivision are required)

DP/SPSectionLot/Portion

Page 2 of 2Certificate application - Water Services division - V4 - July 2020

Forster | 4 Breese Parade | PO Box 450 Forster 2428 | 6591 7222

Gloucester | 89 King Street | PO Box 11 Gloucester 2422 | 6538 5250 Taree | 2 Pulteney Street | PO Box 482 Taree 2430 | 6592 5399

www.midcoast.nsw.gov.au

Privacy: This information is required to process your transaction and will not be used for any other purpose without seeking your consent, or as required by law. Your application will be retained in Council's Records Management System and disposed of in accordance with current legislation. Your personal information can be accessed and corrected at any time by contacting Council.

Contact phoneName

I/we would like to pay via credit card (merchant fee may apply), please arrange for Council's customer service to contact me/us for payment details. Note: if the credit card payment is to be made by someone other than the applicant / owner, please specify below:

I/we have attached a cheque payable to MidCoast Council in the required amount

If you are posting your application to Council, please select your intended payment method

Payment options

Completed form can be: • lodged electronically using the "Submit" button below; or • forwarded by post with payment; or • lodged at our Customer Service Counter - Monday to Friday (excluding Public Holidays).

How to lodge this form

If submitting form electronically, print name - if printing application for posting or lodging at Customer Service, form requires signature

Please refer to Council's adopted fees and charges at www.midcoast.nsw.gov.au. For specific fess related to this application refer to the Water Services Fact Sheet available on the Forms page of our website.

Fees