Central Coast Council

Application for Estimate for Council to:

Connect Development to Sewerage Relocate / Adjust Existing Sewerage Reline Existing Sewer Raise / Lower / Adjust Sewer Manhole

Please send estimate to:

Company Name:

Contact Person:

Address:

Phone No:

Signature:

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

________________________________ Email: _________________________ _________________________________ Date: _______________________________

Type of Development:

Dev. Application No:

Location of Work:

Address:

__________________________________________________________________

_____________________________________________

Lot: _______________ Section: ____________ DP: ____________________

__________________________________________________________________

Please provide an estimate for Council to carry out the following work: (Plans/Drawings are Attached - YES/NO)

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

OFFICE USE ONLY File No: Works Order:

ADMINISTRATION OPERATIONS ____/____/____

____/____/____

____/____/____

Received

Estimate Sent Payment

Received Adjustment

Completed ____/____/____

____/____/____

____/____/____

$____________

____/____/____

____/____/____

____/____/____

____/____/____

Received

Design/Estimate Prepared

Estimated Cost

Works Order Received

Programme Start

Works Completed

Work As Executed to I&D

Final Cost $____________

V1.1 26.3.19 D13495889

Wyong Office: 2 Hely St / PO Box 20 Wyong NSW 2259 Gosford Office: 49 Mann St / PO Box 21 Gosford NSW 2250

P 1300 463 954 l E ask@centralcoast.nsw.gov.au l W centralcoast.nsw.gov.au l ABN 73 149 644 003

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