New South Wales Consolidated Regulations

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WATER (PART 2--GENERAL) REGULATION 1997 - SCHEDULE 3

SCHEDULE 3 – Forms

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 etc Works 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:

Name Portion No Parish County Purpose of Supply

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.

Dated thisday of19

(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 etc Works 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 thisday of19

(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 thisday of19

(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

Occupier Portion No Parish County Tenure

Details of works by which water is to be taken

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 thisday of19

(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

Occupier Portion No Parish County Tenure

Details of Supply Works

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:

1. On which Supply Work is to be constructed:

Portion No Parish County Area Name and Address of owner Name and Address of occupier
2. 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 thisday of19

(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

Occupier Portion No Parish County Tenure

Details of Works by which water is to be taken

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 thisday of19

(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

Occupier Portion No Parish County Tenure over land

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)
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 thisday of19

(Signature of Applicant)

Form 8 - Licence under section 12 of the Water Act 1912

(Clause 8)

No

Date issued:

Name and address of licensee

Details of Licensed Works

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.

Form 9 - Licence under section 13A of the Water Act 1912

(Clause 8)

No

Date issued:

Name and address of licensee

Details of Supply Works (plan attached)

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.



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