Office Use Only NWL Reference No ______________________ Return completed form to: developmentenquiries@nwl.co.uk

Or post to:

Developer Services Team, Northumbrian Water Limited,

Leat House, Pattinson Road, Washington, NE38 8LB

Note 1 –	Please complete all relevant sections. Fields marked * are mandatory, an application will not be processed if left blank. Refer to the Pre Planning Enquiry Guidance Notes or contact our Developer Services Team for further assistance on 0191 4196559

Note 2 – It is advisable to have a copy of the current water/sewer records available when completing this form. If you do not have a copy please contact us on the above number to arrange for a copy of the records relevant to your development site, to be issued to support your submission.

Section 1 – Applicant Details

Please tell us who you are, how we can get in touch and what type of organistation you represent

1.1 Please tick as appropriate : Developer Consultant Self Lay Provider NAV

Contact Name *	Company *
Address *
Postcode *	Email
Telephone *	Mobile

Section 2 – Site Details

We need to know where the site is and what it is/was used for.

2.1 Location: (please supply a scale location plan showing the site boundary outlined red):

Address *
Postcode	Local Authority *
OS Grid Ref.	Site Area (Ha) *

2.2 Classification: * (Tick appropriate box)

Greenfield	or	Brownfield	or	Mixed

2.3 Brownfield Details:

Current/Previous Use *
Drained Impermeable Area (Ha) *	Demolished (Y/N)*	Year *

2.4 Existing Sewer Connections: *

Connection Details	Connection 1	Connection 2	Connection 3	Connection 4	Connection 5	Connection 6
Manhole No.
Connection Diameter (mm)
FW, SW or Combined
Discharge Rate (l/s)

2.5 Existing Water Supply:

Estimated Usage (l/s)	Metered (Y/N)	Serial No.

Section 3 – Development Details

We need to know what you are building and where you are building it.

3.1 Developer:

Contact Name	Company
Address
Postcode	Email
Telephone	Mobile

3.2 Development: *

Development Type	Units	Imp. Area (m2)	Development Type	Persons	Imp. Area (m2)
Residential (Houses)	Office
Residential (Flats)	Hospital
Caravans	Care Home
Retail	School
Industrial	Student Accommodation
Other (Please provide details)

3.3 Phasing:

Estimated date of first occupation	Estimated annual completion rate ( nr)

3.4 History: *

Status/Permissions	Date	Reference	Comments
Previous NWL Enquiry/Contact
Included in Local Plan
Planning Permission – Outline
Planning Permission – Full

3.5 Proposed Sewer Connections: (Flow calculations to be based on current edition of Sewers for Adoption)

Connection Details	Connection 1	Connection 2	Connection 3	Connection 4	Connection 5	Connection 6
Manhole No. (New/Existing?) *
Connection Diameter (mm)
FW, SW or Combined *
Drained Impermeable Area (Ha) *
Discharge Rate (l/s) *

3.6 Proposed Water Supply:

Estimated Demand (l/s)	Domestic Use	Non-Domestic use	Comments

Section 4 – Enquiry Type & Method of Payment

4.1 Please tick the appropriate box below: *

The costs associated with this process can be found in our current charges scheme at www.nwl.co.uk/developers/our-charges.aspx

Water	Sewerage	Water & Sewerage

4.2 Fee Payee:

Contact Name *	Company *
Address *
Postcode *	Email
Telephone	Mobile

4.3 Payment Method: * (Tick preferred option)

Cheque (Including VAT payable to Northumbrian Water Ltd)	Debit/Credit Card (An adviser will call fee payee to take payment)	Invoice (Invoice will be sent to fee payee)

Section 5 – Declaration

I agree, that for the purposes of the Water Industry Act 1991, Water Act 2003 and the Data Protection Act 1998, the information provided in this form and in any accompanying documents, may be held on a computer and processed by Northumbrian Water Ltd and its servants and agents for all purposes connected with the Company’s statutory water and sewerage undertakings.

Full Name	Position
Signature	Date