Water Resource Consents Assessment Form
Applicant Details
Applicant Name
Organisation
Address
Contact Number
Email
Site Information
Site Address
Legal Description
Coordinates (Lat, Long)
Consent Type
Type of Consent
Water take
Dam
Discharge
Diversion
Other
Consent Duration (years)
Activity Details
Description of Proposed Activity
Purpose of Water Use
Volume Requested (m³/day)
Source of Water
Assessment of Environmental Effects
Potential Effects on Environment
Proposed Mitigation Measures
Additional Information
Supporting Information
Declaration
I declare that the information provided is true and correct to the best of my knowledge.
Signature
Date