Applicant Information

Name  of Applicant

Date

Case Officer

Contact Details of Applicant or Representative

Last Name

First Name

Email

Postal Address

City

Phone No.

Mobile No.

Property Details

Sub Catchment

Quaternary Catchment

Reference Number

Property Name

Number

Portion

Administrative District

Project Description

Applicable Water Uses

S 21

Description

Applicable

Yes

No

(a)

Taking water from a water source

(b)

Storing water

(c)

Impeding or diverting the flow of water in a watercourse

(d)

Engaging a stream flow reduction activity

(e)

Engaging in a controlled activity

(f)

Discharging waste or water containing waste into a water resource through a pipe, canal, sewer or other conduit

(g)

Disposing water in a manner which may detrimentally impact on a water resource

(h)

Disposing in any manner of water which contains waste from, or which has been heated in, any industrial or power generation process

(i)

Altering the bed, banks, course or characteristics of a watercourse

(j)

Removing, discharging or disposing of water found underground if it is necessary for the efficient continuation of an activity or for the safety of people

(k)

Using water for recreational purposes

General Required Information

Official Use

Description

Applicable

Submitted

Yes

No

Yes

No

Proof of Payment of Licence Application Processing Fee (Compulsory)

Copy of Identity Document of Applicant or Delegated Person (Compulsory)

Copy of Company Registration Certificate (Compulsory)

Copy of Trust Registration Certificate (Compulsory)

Letter of Authorisation for Companies, Trusts or Legal Entities (Compulsory)

Letter of Authority or Power of Attorney to Apply on behalf of Applicant

Copy of BBBEE Certificate

Letter of Consent if the Applicant is not the Property Owner (Compulsory)

*Applicant Information Form: Individual (DW 756 / 769)

*Applicant Information Form: Water Service Provider (DW 757 / 770)

*Applicant Information Form: Company, Partnership, Government (DW 758 / 771)

*Applicant Information Form: Water User Association (DW 759 / 772)

*Property Details Form (DW 901)

Property Owner Details (DW 902)

Permission to Occupy (PTO), Title Deed, Lease Agreement, Community Resolution

A description of the location of the activity, including

When providing coordinates, such coordinates must be provided in degrees, minutes and seconds using the Hartebeesthoek 94 WGS84 coordinate system.

a plan which locates the proposed activity or activities applied for at an appropriate scale, or if it is—

Where applicable, proof of acceptance of an application for any right or permit in terms of the Mineral and Petroleum Resources Development Act, 2002 or environmental authorisation as per regulation 7 must be provided

Section 27 Motivation

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21(a): Taking water from a water resource

Official Use

Applicable

Submitted

Yes

No

Yes

No

*Taking water from a water resource Form (DW 773)

*Pump Technical Data Form (DW 784)

*Canal Technical Data Form (DW 786)

*Irrigation Field and Crop Details (DW 787)

*Supplementary Info: Power Generation, Industrial or Mining (DW 788)

*Supplementary Info: Domestic, Urban, Commercial or Industrial (DW 789)

Soil Suitability Report (for irrigation from Dept. Agriculture)

Viability Confirmation (for permanent transfers from Dept. Agriculture)

Confirmation of no Land Claims (for permanent transfers from Rural Development and Land Reform)

Recommendation from CCAW (for reserved water)

Recommendation from WUA or IB (for scheme related water use)

Stakeholder Consultation with Interested and Affected Parties

Pump Test Certificate (Groundwater)

Geo-hydrological Study (Groundwater)

Technical Design Report in support of the water use applied for

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21(b): Storing water

Official Use

Description

Applicable

Submitted

Yes

No

Yes

No

*Storing water form (DW 774)

*Dam and Basin Technical Data Form (DW 789)

*Dam Classification Form (DW 793) (for dams > 5m and > 50 000m3)

Technical Design Report in support of the water use applied for (Hydrological study)

Dam Design Drawings or As Build Drawings in case the Dam is already constructed

Dam Capacity Curve

Dam Location Map

Master Layout Plan (1:100 year flood line and delineation)

Regional Maximum Flood (RMF) and Spillway Capacity Calculations

EIA and EMP

Environmental Authorisation

Stakeholder Consultation with Interested and Affected Parties

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21(c) & (i): Impeding & Altering

Official Use

Description

Applicable

Submitted

Yes

No

Yes

No

* Impeding or diverting the flow of water in a watercourse form (DW 763)

*Altering the bed, banks, course or characteristics of a watercourse (DW 789)

*Supplementary Information for 21(c) & (i) form (DW 775)

Relevant Environmental Impact Assessment Studies

Wetland Delineation Study

Method Statement

Environmental Management Plan

Storm Water Management Plan

Hydrological Studies

Design Drawings or As Build Drawing if the structure is already been built

Rehabilitation Plan

Master Layout Plan (Must include all infrastructure, water courses, scientific determined buffers, flood lines, riparian habitat, and ecologically valued features; on A1 paper

Landscape Maintenance Plan

Pollution Plume Map / Drawings

Cone of Depression Drawings

Plant Species Plan (A1 paper)

Monitoring Programme and Auditing Plan

Alternatives that will address the hierarchy of impacts, starting with the exclusion of watercourses

Stakeholder Consultation with Interested and Affected Parties

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21(e): Engaging a controlled activity

Official Use

Applicable

Submitted

Yes

No

Yes

No

* Engaging in a controlled activity form (DW 765)

*Monitored Waste Discharge Details form (DW 904)

*Irrigation Field and Crop Details (DW 787)

Geohydrological Study

Water Quality Report

Soil Analysis

Stakeholder Consultation with Interested and Affected Parties

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21(f) : Discharging waste or water containing waste into a water resource through a pipe canal sewer or other conduit

Official Use

Description

Applicable

Submitted

Yes

No

Yes

No

* Discharging waste or water containing waste into a water resource through a pipe, canal, sewer or other conduit form (DW 766)

*Monitored Waste Discharge Details form (DW 903)

Water Quality Report

Integrated Waste Water Management Plan (IWWMP)

Stakeholder Consultation with Interested and Affected Parties

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21(g) : Disposing of waste in a manner which may detrimentally impact on a water resource

Official Use

Description

Applicable

Submitted

Yes

No

Yes

No

* Disposing of waste in a manner which may detrimentally impact on a water resource form (DW 767)

*Monitored Waste Discharge Details form (DW 904)

*Details of Waste Management Facility form (DW905)

Water Balance

Design Drawings of Waste Management Facility and Report

Geohydrological Report

Integrated Waste Water Management Plan (IWWMP)

GN 704 Motivation

Stakeholder Consultation with Interested and Affected Parties

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21 (h) Disposing in any manner of water which contains waste from, or which has been heated in any industrial or power generation process

Official Use

Description

Applicable

Submitted

Yes

No

Yes

No

* Disposing in any manner of water which contains waste from, or which has been heated in, any industrial or power generation process form (DW 780)

*Monitored Waste Discharge Details form (DW 903)

Water Balance

Water Quality Report

Integrated Waste Water Management Plan (IWWMP)

Stakeholder Consultation with Interested and Affected Parties

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21(j): Removing, discharging or disposing of water found underground if it is necessary for the efficient continuation of an activity or for the safety of people

Official Use

Description

Applicable

Submitted

Yes

No

Yes

No

* Removing, discharging or disposing of water found underground if it is necessary for the efficient continuation of an activity or for the safety of people form (DW 780)

Water Balance

Geohydrological Report

Stakeholder Consultation with Interested and Affected Parties

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Section 21 (k): Using water for recreational purposes

Official Use

Description

Applicable

Submitted

Yes

No

Yes

No

* Using water for recreational purposes form (DW 780)

Public Private Partnership (PPP) Approval

Approval as per section 116 of the National Water Act, 1998 (Act 36 of 1998)

Stakeholder Consultation with Interested and Affected Parties

Other information as requested in the acknowledgement of receipt and where applicable the site visit and meeting:

Site Inspection Information

Date of Site Inspection

Parties Present at the Site Inspection

Name and Surname

Designation

Contact Number

Signature

Site Inspection Report