Water & Wastewater Connection Application Form
Particulars of Applicant
Name:
Address:
Phone:
Fax No.:
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Particulars of Property Owner
Name:
Address:
Phone:
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Property Requiring Connection
Property Type:
Lot No.:
Street No.:
Street Name:
Town & Postcode:
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Particulars of Licenced Plumber
Name:
Licence Number:
Contact No.:
Fax No.:
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Water Service Connections NOTE: Standard residential connection is for 20mm only.
Connection Type:
Quantity Required:
Size:
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Wastewater Connections
Connection Type:
How many fixture units are being added?
Note: Sewer Connection Point Field Note will be faxed to the plumber. 'As Laid' sanitary drainage plans must be submitted by the plumber to Casey Services (Aust) on the template provided by Gippsland Water within 5 days of completion of work.
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Payment Method
Payment Type:
Note: If you are paying by card, someone from Gippsland Water will contact you shortly for your payment details
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Payment/Quote Details
Note: If quoted, please list quotation number and amount of fees to be receipted.
WATER
Quote No.
Fees: $
WASTEWATER
Quote No.
Fees: $
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