APPLICATION TO SINK A BOREHOLE OR USE ALTERNATIVE
WATERSOURCES OTHER THAN MUNICIPAL
W&S/WPC_FORM_028
16/09/2015
WATER AND SANITATION DEPARTMENT
COMPILED BY: QUALITY MANAGEMENT REPRESENTATIVE
Version: 2
APPROVED
Regulation
Page 1 of 2
BY:
HEAD:
Policy
of
WATER AND SANITATION
WATER DEMAND MANAGEMENT
Nokuzola Mhlungu
Head: Policy and Regulation
T: 0215901669 F: 086 576 2367
E: Nokuzola.mhlungu@capetown.gov.za
APPLICATION TO SINK A BOREHOLE / WELL AND / OR USE WATER FROM SOURCES OTHER
THAN THE MUNICIPAL WATER SUPPLY
(IN TERMS OF CHAPTER 10 OF THE WATER BY LAW PG 6847; LA 22920)
General
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Name of applicant:
Owner of property:
Type of property:
(residential/ commercial/ industrial / other)
Physical address:
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Email address:
Tel/cell no:
Existing Municipal Water Supply Meter Number (s):
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Municipal account number (s):
Abstraction
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Location of abstraction site:
(attach map showing the points of abstraction)
Source of supply (surface/ underground)
Please specify:
What is the yield of the supply:
Depth to water level:
Operating days per year:
Number of people in the building per day:
Annual rainfall in the area:
What is the purpose of the proposed abstraction
(toilet flushing, irrigation, etc.?)
CIVIC CENTRE
IZIKO LOLUNTU
BURGERSENTRUM
12 HERTZOG BOULEVARD CAPE TOWN 8001 P O BOX 298 CAPE TOWN 8000
www.capetown.gov.za
Making progress possible. Together.
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How much water do you require: (kl/day)
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How have you calculated this amount:
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How do you propose to abstract the water
(Gravity feed, pump, etc.?)
*A METER MUST BE INSTALLED TO MEASURE
THE AMOUNT OF WATER ABSTRACTED
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How do you propose to log/ record the amount of
water abstracted:
Start date:
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When do you propose to abstract the water:
End date:
Discharge
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Do you intend to discharge used water from this
source:
Where will you discharge the water:
(Municipal sewer / other; please specify)
Do you have consent from us to discharge water from
this site:
Will the discharge be measured:
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Yes
No
Yes
No
Yes
No
How:
Undertaking
I certify that the information furnished above is true to the best of my knowledge and belief and I am
aware if any part of the information submitted is found to be false / misleading at any stage, the
application will be rejected / permission revoked.
………………………………
Signature of applicant
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Please send your completed application form and supporting documentation to:
Policy and Regulation
Water Demand Management & Strategy
City of Cape Town
P O Box 100
Goodwood
7459
Alternatively, it can be emailed to Borehole.water@capetown.gov.za with “APPLICATION for borehole/ well/
alternative source. ATT Nokuzola Mhlungu” in the subject line.
Page
All
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Reason for change
Original development
Approval
Amended form
CHANGE LIST
Ver.
Reviewer
0
QMR
1
N. Mhlungu
2
QMR
Approved by: ______________________ Signature:
Head: Policy and Regulation
Release Date
10/03/2014
07/04/2014
15/09/2015
_______________________
Date: _______________________