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Permit Application Form - SA Water

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SA Water Use Only Ref No:

New Swimming Pools

Level:

Date Received: Status:

Permit Application Request

A

Duration:

R

NPR

P

Please note all fields are mandatory and must be completed for the application to proceed. Applications are assessed on a case by case situation and permit approval is based on all the required information being provided to SA Water. Please allow 10 business days from lodgement of application for permit approval/assessment. This application is applicable for new swimming pools whereby either a contract has been entered into or the purchase took place on or after December 1, 2010. This application form must be completed by either the SA Water account holder or tenant. If the SA Water account or tenacy is in the name of more than one person it is acceptable for one only of the named account holders or tenants to complete the application. It is also acceptable for more than one to do so.

1.Applicant/s property details (N.B.Section 2 must be completed if the tenant is the applicant) Title: Mr Mrs Miss Ms First Name: SA Water Account Number: __ __ __ __ __ __ __ __ __ __

Last Name: Owner

Tenant

Residential

Non residential

Property Address/Lot or Street Number: Street Name:

Suburb/Town:

Postcode:

Postal address:

Suburb/Town:

Postcode:

Phone number - After hours:

Phone number - Office hours:

Mobile:

Fax:

E-mail Address: 2. Authorisation details (Applicants who are under a leasing arrangement or other arrangement and whose names do not appear on the SA Water property account will need to obtain authorisation from the account holder through their signature below. The account holder, by signing the below section also authorises the historical and current water consumption details and associated financial charges be supplied to the permit applicant and that it remains the account holder’s responsibility to organise the payment of the SA Water account) Please disregard this section if the account is in your name I/We hereby authorise the above applicant to submit a new swimming pool application form for the property detailed on this form. I/We understand that if a permit is approved by SA Water that the above applicant will be responsible for the conditions outlined in the permit and that SA Water may provide water consumption details to the permit holder from the SA Water account relevant to this property. I/We understand that it remains the account holder’s responsibility to organise the payment of the SA Water account. Full Name: Organisation:

(If applicable)

Property and SA Water account details correct? Yes  No  If no, please provide correct details below: Business phone or mobile number: Signature: 3.Pool Company details Contact person:

Position:

Business name:

ABN:

Postal address:

Suburb/Town:

Phone number - Office hours:

Fax:

E-mail Address: Please provide details for associated membership/s: Does the pool company require a copy of the permit? Yes Application continues on the next page

No

Postcode:

4.New Swimming Pool details (Prior to a 30 day or 60 day permit being approved you must provide proof of purchase of a Smart Approved WaterMark pool cover/blanket/liquid blanket with the application) Please indicate  whether your pool is: Residential

Commercial

It is a condition that a Smart Approved WaterMark pool cover/blanket/liquid blanket is purchased to comply with permit conditions. www.smartwatermark.org Please ensure the proof of purchase is attached/enclosed.

or Public

And is: Indoor

or Outdoor

What will be accepted by SA Water as proof of purchase? A copy of the contract from the pool company or a receipt from the retailer providing full details of the Smart Approved WaterMark cover/blanket/liquid blanket. Quotes will not be accepted.

Please indicate  the pool construction type and whether it is a permanent fixture or temporary fixture: Concrete – 60 day permit

or Fibreglass – 30 day permit

Please provide details of Smart Approved WaterMark pool cover/blanket/liquid blanket

Permanent above ground – 30 day permit (e.g. permanent fixture pool will not be dismantled)

Brand Name:

Temporary above ground – 30 day permit

Product or Model number:

(e.g. pool to be dismantled once summer period is complete) Description: Please indicate the volume of drinking water being used to fill the swimming pool in litres/kilolitres:

Micron Value:

Example: Length (m) x Width (m) x Water Depth (m) = total kL i.e. 1 kilolitre (kL) = 1000 Litres (L)

Number of months of liquid pool blanket supply: (Must be at least 6 or more months supply)

Estimated fill date: ____/____/________ (The estimated fill date will be the permit start date, please allow 10 business days notice prior to the fill date)

Does the pool have automatic top up installed? Yes

Is your proof of purchase attached? Yes

No

No

If no, your application will be rejected. If yes, is a suitable backflow prevention device installed? Yes

No

5.Water efficiency initiatives inside and outside your home or business: Please indicate  if you have any of the following in/on your property as these activities will be considered in assessing your application and will be valuable information for benchmarking purposes. Water Tap Restrictor Devices

Pool/Spa Cover

Tap Aerators or Tap Mixers

Garden Tap Timer

Water Efficient Shower Heads

Garden Mulching

Water Efficient Washing Machine

Rainwater Tank/s

Water Efficient Dishwasher

Drip Irrigation System

Please provide any further information relevant to water efficiency iniatives/reduced water use inside and outside your home or business below:

Application continues on the next page

General Conditions for Granting Permits: SA Water may issue permits under Part 6 of the Water Industry Regulations 2012 1. The submitted application must be filled out with each applicable section completed and signed by the SA Water Account holder/s or tenant/s of the property for which the permit is being applied for. If the tenant has completed the application form, section 2 must be filled out and signed by the SA Water account holder/s of the property where installation will take place. 2. Appropriate access to the property for which the permit is being applied for will be provided to enable the South Australian Water Corporation to conduct a site audit should further information be required to complete the approval process and/or to ensure the terms and conditions of the approved permit are being adhered to. 3. Appropriate documentation is attached with the application. (refer to section 4) 4. The SA Water account holder/s and or tenant/s must demonstrate a commitment to water efficiency initiatives on the property for which the permit is being applied for. (refer to section 5) 5. If approved, concrete pools will be provided with a 60 day period to fill and fibreglass, above ground and temporary pools will be provided with a 30 day period to fill from the requested date nominated on the application form. 6. All specific requirements contained within the permit including full terms and conditions must be adhered to. 7. Information provided on the application form which is related to the swimming pool may be used for statistical and benchmarking purposes. Personal information will not be disclosed except in accordance with SA Water’s privacy policy a copy of which can be found at SA Water’s website http://www.sawater.com.au. 8. SA Water supplied drinking water must not be used contrary to the current Water Wise Measures until formal written advice from SA Water Corporation advising that an exemption request has been granted, failure to comply may result in a fine being imposed. 9. It is the applicant’s responsibility to ensure that all relevant fencing and other safety requirements are met prior to filling your pool. SA Water does not monitor compliance with planning, building or safety regulations that apply to pools and spas and accepts no responsibility in this regard. The issue of a permit only operates to authorise the filling of a pool with drinking water and does not relieve the permit holder from complying with applicable legislation such as planning, building and safety requirements. Please visit the Swimming Pool and Spa Association of South Australia website http://www.spasasa.com.au/ or contact your local council for swimming pool/spa safety and regulations. Declaration I/We:  agree to the above General Conditions for Granting Permits; and  declare that the information I/We have provided on this application is true and correct. Full Name (clearly printed in block letters): Signature:

Date: __ __/__ __/________

All specific requirements contained within the permit including full terms and conditions can be found on the approval permit, if approved.

Returning the form: Fax your completed application to 08 7003 3799 or post to: Business Technical Support GPO Box 1751 ADELAIDE SA 5001 or e-mail: [email protected]

Thank you for completing this application form, please allow 10 business days from lodgement with SA Water of a completed application for permit approval/assessment. For further information phone the Water Wise Hotline on 1800 130 952 or visit http://www.sawater.com.au/ To view Smart Approved WaterMark products please refer to www.smartwatermark.org For swimming pool safety and regulations please refer to www.spasasa.com.au or your local council.

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Permit Application Form - SA Water

SA Water Use Only Ref No: New Swimming Pools Level: Date Received: Status: Permit Application Request A Duration: R NPR P Please note all fi...

502KB Sizes 5 Downloads 26 Views

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