"Application for Assistance Leakage Policy Form"
Water and Wastewater Form (WW-1) Water and Wastewater Application Form Assistance under Council’s Water and Wastewater Leakage Policy Before completing this form, please read the Important Information regarding your water leakage application on the reverse of this form. FOR OFFICE USE ONLY RATE ACCOUNT NO: ____________________ PROPERTY NO: PN____________ /36 Name(s) of owner(s) in full: Address of Owner(s): Contact Tel. No: Mobile No: Address of Property where leakage occurred: Real Property Description: Date property purchased: / / Are you (the owner(s)) in receipt of a pension? YES / NO If YES, type of pension: Pension Card Number: Please provide particulars relating to detection of leakage and plumbing repair: Leak Detected: / / Leak Repaired: / / (please attach copy of plumber’s repair receipt) Location of Leak/Comments: I/We, ,believe that the information herein is correct. Signature of Owner(s): Date: / / And/ or agent: Date: / / Please Note: all applications must be accompanied by a copy of the plumbing repair document or, (if none available), a completed Statutory Declaration Form stating the repair date and the location of the leak. e.g. in water pipe under driveway. #1858 6011 Revision 4 (Last modified on 3/12/2008) Page - 1 of 2 Water and Wastewater Form (WW-1) Water and Wastewater Important information regarding your Water and Wastewater Rate Relief Application Water leakage relief applies to a water leak that has occurred in the main supply pipe from the meter to the building. Therefore, tap leaks, pool leaks, hot water system leaks, leaks in showers, bathrooms, toilets, any walls in the building, or any area on the property other than the main supply pipe, does not qualify. Applications MUST be accompanied with a plumbing repair receipt/document. This receipt/document must state (minimum requirements): 1. Date of repair 2. Location of the water leak If a plumbing receipt/document is not available a Statutory Declaration must be provided stating the same above details. Receipts/documents relating to the cost of locating the leak (leak detection) will not be accepted. Water rate relief, if granted will be a 60% reduction of the water lost through the leak. The remaining 40% of the water lost through the leak, along with normal consumption will remain the responsibility of the property owner (note for eligible pensioners that leakage relief will be 85% reduction) Applications are processed in date received order and during busy rating times may take up to 8 weeks. Water leakage relief will only be granted once in a 3 year period. Send completed form to: The Chief Executive Officer Gold Coast City Council P O Box 5042 GOLD COAST MAIL CENTRE QLD 9729 or Fax to: (07) 5596 3653 #1858 6011 Revision 4 (Last modified on 3/12/2008) Page - 2 of 2