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APPENDIX III - Forms under Chapter III. GROUNDWATER DEVELOPMENT AND CONSERVATION


2. PRIOR NOTIFICATION OF BOREHOLE DIGGING OR WELL DRILLING OPERATIONS

II - AUSTRALIA - NORTHERN TERRITORY - Water Regulations, 1999

FORM 3

Regulation 5(1)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

APPLICATION FOR A WATER INVESTIGATION PERMIT
Pursuant to section 36 of the Water Act
(for persons other than those authorised under section 20(2) of the Water Act)

Application No......... (office use only)

1. GENERAL

Name of Applicant:

..........................................................................................


(surname)

(given names)

Postal Address:

..........................................................................................

Post Code............................................................

Phone No..............................

2. PROPERTY AFFECTED BY INVESTIGATION

(a) In relation to the property/properties on which investigation will be undertaken.

(i) Name of *owner/*occupier..................................................................
(ii) Address of *owner/*occupier.............................................................

(b) Property description:

Lot No...................... Section No....................... Hundred of..................
Portion No.................. Township.............................................................
Lease No./Name........................................................................................
(If insufficient space, attach details to this application.)

(c) A map of appropriate scale showing the relevant property/properties should be attached to this application.

3. INVESTIGATION DETAILS

(a) Purpose of investigation (tick as appropriate)

Groundwater
Surface water
Gauging

- temporary
- long term

Water Quality analysis
Bores to be sunk
Approximate number of bores..........
Surface geophysics
Geophysical bore logging
Bore test and pumping
Other. Give details
.......................................................................................................
.......................................................................................................

(b) General description of investigation project and likely timing of execution.

.......................................................................................................
.......................................................................................................

NOTE: ADVERTISING OF APPLICATION

The Controller of Water Resources may give notice of this application to those likely to be affected by its approval.

Signing of this application approves the advertising by the Controller of this application in one edition of a newspaper circulating generally in the locality of the proposed works. The cost of advertising shall be borne by the applicant.

Applicant's Signature...........................
Date......................

To: The Controller of Water Resources
(address)

* Delete as necessary

3. PERMITS TO DIG OR DRILL BOREHOLES AND TO CONSTRUCT WELLS

3.1 The Granting of Permits

Step One - Filing of an application

Format of applications

I - AUSTRALIA - NORTHERN TERRITORY - Water Regulations, 1999

FORM 9

Regulation 7(1)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

APPLICATION FOR A BORE CONSTRUCTION PERMIT
Pursuant to section 57 of the Water Act

Application No......... (office use only)

1. GENERAL

Name of Applicant:

........................................................................................


(surname)

(given names)

Postal Address:

.........................................................................................

Post Code...........................................................

Phone No............................

Property on which bore is, or will be, located -

Lot..................

Section No..............................

Hundred of.........................

Portion No...........................................................

Township...........................

Lease No/name..................................................................................................

I am the *owner/*occupier/*lessee of the property.

Please attach sketch plan showing -

(a) lands in the immediate vicinity (i.e. lot, section, lease numbers, boundaries, etc.) on adjacent allotments or within 500 metres;

(b) location of any existing bores in the vicinity;

(c) location of any effluent trench or waste disposal point within 200 metres;

(d) direction of ground slope;

(e) existing or proposed access tracks;

(f) preferred location of bore.

2. DRILL OR CONSTRUCT A *NEW/*REPLACEMENT BORE

Intended uses of proposed bore:

Yes

No

(a) Stock

(b) Domestic

(c) Irrigation areas larger that 0.5 hectares. Please indicate area and likely crops to be grown.

Type

Hectares



..............

..............



..............

..............



..............

..............



..............

..............





Yes

No

(d) Industrial Use

Nature of Industry........................
Annual water use in kilolitres............

(e) Recreation or Environmental Purposes

Nature of Use.............................
Annual water use in kilolitres............

(f) Community or Multi dwelling supply

No of units...............................
Annual water use in kilolitres............

(g) Hydrogeological Investigation

Attach details of activities and program

(h) Other. Please attach details

..........................................................................................................................................

Note: A Permit to construct a bore does not guarantee the right to extract water for other than basic stock and domestic purposes.

A Licence to Take Groundwater may be necessary, particularly where larger volumes are involved.

3. WORK ON AN EXISTING BORE

Registered number of Bore (if known)......................................................................

Depth of Bore............................. metres. Year of drilling........................................

Casing(s) at present in bore (show each string separately)

(1) Type....... Diam....... /mm from....... m to....... m
(2) Type....... Diam....... /mm from....... m to....... m
(3) Type....... Diam....... /mm from....... m to....... m

Details of cementing..................................................................................................

Details of screen........................................................................................................
....................................................................................................................................

Nature of Work:

(a) DEEPENING THE BORE

State proposed depth of bore.......................................... metres
Any other details..................................................................................................

(b) PLUGGING, BACKFILLING OR SEALING OFF THE BORE

State reasons........................................................................................................

(c) REMOVING, REPLACING, ALTERING SLOTTING OR REPAIRING THE CASING, LINING OR SCREEN, OR ENLARGING BORE DIAMETER

Give details...............................................................................................................
...................................................................................................................................

4. ADDITIONAL COMMENTS/ADVICE/INFORMATION IN SUPPORT OF APPLICATION

...................................................................................................................................

Applicant's Signature...............................................................................................
Date..........................................................................................................................

To: The Controller of Water Resources....................................................................
(address)

* delete as necessary.

____________________________

FORM 14

Regulation 9(1)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

APPLICATION FOR A LICENCE TO TAKE GROUNDWATER
Pursuant to section 60 of the Water Act

Application No......... (office use only)

1. GENERAL

Name of Applicant:

..............................................................................................................


(surname)

(given names)

Postal Address:

................................................................................................................

Post Code.............................................................................

Phone No............................

Property on which bore is, or will be, located -

Lot....................

Section No................................

Hundred of...........................

Portion No.............................................................

Township.............................

Lease No/name.........................................................................................................

I am the *owner/*occupier/*lessee of the property (delete as necessary).

2. INTENDED WITHDRAWAL



Approx

Maximum

(a) IRRIGATION


Annual

Weekly/


Area in

Water

Monthly


Hectares

Volume

Volume

(i) Permanent Planting




(ii) Annual Crop




(iii) Other (describe)




TOTAL




(b) INDUSTRIAL

Type of Industry................................................
Estimated Annual Usage................... kilolitres

(c) RECREATION/ENVIRONMENT

Details...............................................................
Estimated Annual Usage................... kilolitres

(d) COMMUNITY OR MULTI DWELLING SUPPLY

Details..................................................................
Estimated Annual Usage....................... kilolitres

(e) *STOCK AND DOMESTIC

Details.......................................................................
Estimated Annual Usage........................... kilolitres

(f) OTHER

Details.........................................................................
Estimated Annual Usage............................ Kilolitres

3. DETAILS OF BORE AND PUMP (if known)

BORE

PUMP

No.

Depth

Diameter

Type & Power

Capacity l/sec

......

......

.........

...........

.............

......

......

.........

...........

.............

......

......

.........

...........

.............

Method of Irrigation: Spray.......... ha Furrow........ ha
(where applicable) Flood.......... ha Trickle....... ha

4. ADDITIONAL INFORMATION

(a) Will there be any waste water generated by the proposed use? If yes, state estimated quantity and proposed means of disposal

...................................................................................................

(b) A licence is normally granted for two years. However, should you feel there are special circumstances that justify granting a licence for a period exceeding 2 years, full details must be attached to this application.

(c) The Controller of Water Resources may require additional information regarding the effect the proposed extraction will have on the groundwater resource the applicant proposes to exploit.

(d) Additional comments/advice/information in support of application

................................................................................................

Applicant's Signature....................................................
Date.............................

To: The Controller of Water Resources
(address)

* Information required only in those cases where water withdrawn from a bore is used for several purposes, one of which is domestic, stock or home garden use.

_______________________________

II - JAMAICA - Water resources regulations, 1995

THE WATER RESOURCES ACT
APPLICATION FOR CONSENT OF AUTHORITY TO WELL-DRILLING

FORM C

(Regulation 18 (1))

(To be completed in duplicate)

Application No............................

1. Name of Applicant..........................................................................

2. Address of Applicant.......................................................................

3. Location of proposed work or of existing work........................................

4. Indicate the nature of your interest in the land on which well. drilling is to take place (i.e. whether you are owner, lessee. tenant, etc.).........................................................................

5. Name of Drilling Contractor.......................................................................

6. Address of Drilling Contractor...................................................................

7. Purpose of drilling......................................................................................
.........................................................................................................................

8. Technical details:

(i) Estimated depth of borehole or well.............................................. metres

(ii) Diameter of borehole or well............................................... centimetres

(iii) Method of drilling...................................................................................

(iv) Method of construction...........................................................................

(v) In the case of artesian supplies, the method proposed for controlling the flow from the borehole and for preventing leakage around the borehole lining...............................................
.........................................................................................................................

(vi) Other technical information.....................................................................
.........................................................................................................................

9. Any further matters which the Authority should take into account in considering the application.......
..........................................................................................................................
..........................................................................................................................

Note:

Completed forms must be accompanied by

(1) two copies of a map on a scale of 1: 50,000 showing location of proposed well along with such other maps, documents and information as the Authority may require; and

(2) the relevant fee.

I hereby apply for the consent of the Authority. under the Water Resources Act for the drilling of a well and hereby declare that to the best of my knowledge the above particulars are true and correct.

................................................

Signature of Applicant

Date.......................................

___________________________

To be completed by the Secretary of the Authority

Indicate whether application granted or refused.......................
Date of grant or refusal..............................................................
If application refused. reason for refusal..................................

...........................................
Secretary.
Water Resources Authority.

.................................
Date

___________________________

III - UGANDA - Water Resources Regulations, 1998

SIXTH SCHEDULE
THE REPUBLIC OF UGANDA
THE WATER STATUTE, 1995
The Water Resources Regulations, 1998

FORM F1

Regulation 16 (2)

APPLICATION FOR A CONSTRUCTION PERMIT
To be completed in triplicate (3)

1. NAMES AND ADDRESSES

Names of Company/Cooperative Society/Public Corporation/Partnership*....................
Address:............................................................................................................................
Telephone:........................................................................................................................
Designation:......................................................................................................................
Acting for Company/Partnership/Public Corporation/NGO/Cooperative Society*..........
Postal address (if different from above):..........................................................................
District:.............................................................................................................................
Main Activity:..................................................................................................................

*Delete what is nor applicable.

2. COMPANY/CO-OPERATIVE SOCIETY/PUBLIC CORPORATION/PARTNERSHIP NAME

Will you work for a company under your permit?

() Yes

() No

If Yes, please give the name, address, registered number and trading licence of that company:

Name:..........................................................................................................................
Address:.......................................................................................................................
Date of registration:.....................................................................................................
Trading Licence No:....................................................................................................

3. EQUIPMENT

List the relevant construction equipment and vehicles possessed by you or your employer. Attach an extra sheet of paper if necessary.

4. STAFF

Give brief details of the name, age, relevant qualifications and experience of any people employed by you or the company, who will work on construction under the permit.

5. YOUR EXPERIENCE

What formal qualifications do you have to undertake a construction work?.................
.........................................................................................................................................
.........................................................................................................................................

Give details of any previous construction permit which you have held:........................
.........................................................................................................................................
.........................................................................................................................................

Give the following details about any construction work you have previously undertaken:

Client name:....................................................................................................................
.........................................................................................................................................

Description of work:.......................................................................................................
.........................................................................................................................................

Date of work:..................................................................................................................
.........................................................................................................................................

6. FURTHER RELEVANT INFORMATION

Attach any other relevant infonnation to the one already specified

DECLARATION OF THE APPLICANT

I certify that the infonnation provided in this form is correct to the best of my knowledge. I also agree that no decision will be made nor action taken with respect to this application until I recleve a notification from the Directorate of Water Resources that I have provided all the necessary infonnation.

Signature of applicant

Official seal/stamp

Full names

Date:

NOTE: When you have completed this form and the appropriate attachments, you must attach CASH or CHEQUE for Ushs. for processing the application and send them to:

The Director
Directorate of Water Resources
P.O. Box 20026
Kampala

The Director may require you to advertise this application at your cost in a way specified by the Director.


OFFICIAL USE ONLY

RECEPTION DATE: (D)

(M)

(Y)

APPLICATION NUMBER



Step Two - Review of applications

III - CAYMAN ISLANDS - Water Authority Regulations, 1985

Schedule 1
Notice of Application for a Licence to Abstract Groundwater

In accordance with the Water Authority Law,

I

...................................... hereby give notice of my intention to... abstract


(Name)

groundwater for other than domestic use... on Block No.........; Parcel No........;

being in the district of............................................................................................


(District)

Plans for this proposal can be viewed free of charge at the Water Authority office at any reasonable hour. Any person wishing to make objections should do so in writing to the Water Authority within 14 days of the date of publication of this notice.

___________________________

III - AUSTRALIA - NORTHERN TERRITORY - Water Regulations, 1999

FORM 4

Regulation 5(2)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

NOTICE OF APPLICATION
Pursuant to section 36 of the Water Act

I,.................................................................................................... (the Controller)
hereby give notice of an application for a Permit to Investigate for Water on land
situated at................................................................................................................ (description of land)

Any enquiries concerning this application should be directed to the (name of person).

Any objection to the issue of such a Permit must be forwarded in writing to reach me at(address), within 30 days of the date hereof.

Dated
Controller of Water Resource

3.2 Format of permits

IV - CAYMAN ISLANDS - Water Authority Regulations, 1985

Schedule 1
Groundwater Abstraction Licence

1. Licence No.


2. Licence holder:


3. Address:


4. Location of well: Parcel No.

Block No.

5. Type of well:


6. Works authorized:


7. Date by which works to be completed:


8. Maximum daily abstraction quantity:


9. Maximum abstraction rate:


10. Purpose of use:


11. Date of expiration:


12. Fee:

Paid:

This licence is granted subject to the provisions of the Water Authority Law No. 18 of 1982, and the special conditions specified.

Failure to comply with the provisions of the Law, or with the terms and conditions of this licence may result in the penalties specified in section 51(1) and (3) of the Law, and the modification or revocation of this licence.

Date:

Signature and seal of Authority:

___________________________

V - AUSTRALIA - NORTHERN TERRITORY - Water Regulations, 1999

FORM 5

Regulation 5(4)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

WATER INVESTIGATION PERMIT
Pursuant to section 36 of the Water Act

Permit No......

Subject to full compliance with the Water Act, Regulations and the terms and conditions set out below, permission is granted to................................... of.................................. to enter the land situate at Lot No............................. Section No............................. Hundred of............. Portion No....................... Township............................

Lease No./name..................... to investigate for water.

This Permit remains in force for a period of....................... months from the date of this Permit.

Terms and Conditions

1. The permittee shall give notice in writing to the owners and occupiers of all of the lands abovementioned upon which he wishes to enter for the purpose of the water investigation at least 14 days prior to entry. Any such notice shall clearly indicate the work proposed to be carried out on the land and the name and place of business of each person who will enter on the land to carry out the work.

2. This Permit does not entitle the permittee to enter upon any lands -

(a) within the curtilage of any dwelling house;

(b) upon which any crop, vines or orchard is situate;

(c) occupied pursuant to a mining tenement within the meaning of section 4 of the Mining Act other than with the permission of the tenement holder.

3. Any structure, equipment or any other thing attached to the land pursuant to this Permit shall not be deemed to have become a fixture for the purpose of giving the owner or occupier of the land a proprietary interest in such structure, equipment or thing.

4. The permittee shall ensure that as little damage as is practicable is done to any land entered pursuant to this Permit and that, upon completion of the investigations, the land is restored as nearly as is reasonably practicable to the condition in which it was before the commencement of the investigations, or alternatively in accordance with prior agreement between the parties. The Permit holder is liable for compensation to the land holder for damage caused by entry or works.

5. The permittee shall furnish copies of any data obtained during the investigation to the Controller of Water Resources at the end of the investigation period or as otherwise required by this Permit and at such times as the Controller may request during the operation of this permit.

6. The following specific conditions will apply -

Controller of Water Resources......................
Date................................................................

Note: Every application for a reissue of a permit shall be made not later than one calendar month prior to the date of expiry of this permit.

___________________________

FORM 10

Regulation 7(2)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

BORE CONSTRUCTION PERMIT
Pursuant to section 57 of the Water Act

Permit No......

Subject to full compliance with the terms and conditions set out below, permission is granted to....................................... of to undertake the following work.................... located at Lot.............. Section No.......................... Hundred of............................ Portion No....................... Township....................................... Lease No./name......................................................

Such work must be completed within 12 months from the date of this Permit.

Terms and Conditions

1. All work will be undertaken in accordance with sound water bore drilling practices, to the satisfaction of the Controller of Water Resources.

2. Work will only be carried out by persons holding a recognised......................... drilling licence.

3. The following specific conditions will apply:
...............................................................................................................................
...............................................................................................................................

Controller of Water Resources..............................
Date.......................................................................

Note: Every application for a reissue of a Permit shall be made not later than one calendar month prior to the date of expiry of this Permit.

___________________________

FORM 15

Regulation 9(2)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

LICENCE TO TAKE GROUNDWATER
Pursuant to section 60 of the Water Act

Licence No.......

Licensee:

Expiry Date
// (if applicable)

Water District

Address:

Registered Number of bore(s)

Purpose: kilolitres per year



Irrigation............................

LOCATION OF PROPERTY

Industrial.................................


Recreation/Environment.........................................


* Domestic or Stock


Community..........................................


Other...................................................


TOTAL:..............................................

The holder of this licence may withdraw the quantity of ground-water stated above from the listed bore(s), subject to the provisions of the Water Act, Regulations and the following terms and conditions.

Terms and Conditions

1. All water withdrawn or taken under this licence shall be used on the land in respect of which this licence is issued for the purposes endorsed on the licence and may not be used on any other land or for any other purpose without approval of the Controller of Water Resources.

2. This licence shall be valid for the period endorsed on the licence subject to Condition No. 3 below.

3. This licence may be revoked, suspended or modified at any time in the circumstances and in the manner prescribed by the Water Act.

4. The holder of the licence shall not permit any withdrawn water to be wasted

5. The holder of the licence shall furnish returns of quantity of water withdrawn if so requested.

6. The following specific conditions shall apply -

Controller of Water Resources....................................
Date.............................................................................

Note: Every application for a reissue of a licence shall be made not later than one calendar month prior to the date of expiry of this licence.

Only in cases where water withdrawn from a bore is used for several purposes, one of which is domestic, stock or home garden use.

VI - JAMAICA - Water resources regulations, 1995

FORM D

(Regulation 18 (2))

Consent No...................

THE WATER RESOURCES ACT
CONSENT OF THE WATER RESOURCES AUTHORITY TO WELL-DRILLING

................................................................................................................................ of
Name

....................................................................................................................................
Address

is hereby given consent to:
sink ()
enlarge () Tick as appropriate
otherwise alter ()

a well on land located at.........................................................................................
.................................................................................................................................
subject to the provisions of the Water Resources Act and Regulations made thereunder and to such terms and conditions 81 are specified herein.

Terms and Conditions

1. This consent shall be valid for a period of.............................. from the date hereof. subject to the provisions of the Act and the regulations relating to its revocation, suspension and variation.

2. The following works only are hereby authorized to be done: -
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................

Additional Terms and Conditions (if any).

Dated this day of 19

Seal

.........................................
Secretary.
Water Resources Authority.

___________________________

VII - UGANDA - Water Resources Regulations, 1998

SIXTH SCHEDULE
THE REPUBLIC OF UGANDA
THE WATER STATUTE, 1995
The Water Resources Regulations, 1998

FORM F3

Regulation 19 (1) and (2)

CONSTRUCTION PERMIT
To be completed in triplicate (3)

Permit No................................................................................................................
Name and Address..................................................................................................
.................................................................................................................................
You are hereby authorised to carry out the following works:................................
.................................................................................................................................
.................................................................................................................................
Location (District. County, Sub-county, Parish, Villages, Volume/Block, Folio Number/Plot Number):
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................

This permit shall be valid from (date)............................. to (date).........................

In addition to the extra conditions specified in these regulations and other law in force, this permit is subject to the following conditions:

1...............................................................................................................................
2...............................................................................................................................
3...............................................................................................................................
4...............................................................................................................................
5...............................................................................................................................
6...............................................................................................................................
Date:.........................................................................................................................

Signature

Official Stamp

....................................................
Name
Director of Water Resources

3.3 General obligations of permit holders

VII - SAUDI ARABIA - Executive Order No. 14-62 of 1989: By-laws of the Water Resources Preservation Regulations.

Kingdom of Saudi Arabia

No. 18

Ministry of Agriculture & Water

Date:.....................................

Water Preservation Dept.


Permits & Control Section

Serial No.

Subject: Drilling Permit

The Director of......................
Branch Office of the Ministry

Dear Sir,

Reference is made to the request of Mr..................................... submitted to this Dept. with your letter No dated /../ regarding a permit for drilling a........... on a farm, located in........., owned by........., the boundaries of which are:.......... east........... west............ south............ north, for the purpose of irrigation.

The information forwarded by you indicates that the said farm is already existing and that it is in need of a water well. Therefore, the concerned Tech. Dept. of this Ministry sees no objection to issuing this permit provided that the drilling shall be performed within the farm limits and that no trespassing shall occur on the lands of any other farmer. The Drilling contractor shall abide by the following:

The Contractor shall undertake to use the equipment necessary to execute the contractual work and he shall supply all the required technicians and labour to carry out the job.

Both parties to the drilling contract shall follow these conditions:

1- The well depth shall not exceed.m.

2- Well casing pipes shall be used, and cement shall be used around the casing to fill the space between the casing and the well walls.

3- The distance between the proposed well and any other well on the same farm shall not be less than 500 m.

The contractor shall comply with the following:

1- The well must be drilled vertically using safety materials, the necessary casing, cement and well screens.

2- The verticality of the well shall be tested every 100 feet, and in case of any deformity of the bore the contractor shall correct it, or drill a replacement well at his own expense.

If the well is drilled in an improper way resulting in water leakage, or if it shows within one year of its drilling, any defect that may affect the best use of it, the Contractor shall plug it tightly and replace it by another one.

If the well is drilled in areas which have some water problems, like a high water level, flowing water etc., the Contractor shall then use some control facilities to preserve water resources.

1- The Contractor shall use good quality materials such as API H (40) casing pipe specifications and the weight shal1 not be less than 48 lbs/ft for 13 ½ inch pipe, but 36 lbs/ft for 9 5/8 inch pipe, and 23 lbs/ft for 7 inch pipe.

2- The Contractor shall be responsible for the installation of casing and in case pipes used are different in specifications he will be responsible. Moreover he will be responsible for any violations of the permit provisions, such as drilling on a farm not covered by a permit.

The Contractor shall not start his operations in an area already covered by a permit, and where the conditions above prevail, until often period of 15 days has elapsed after providing the Ministry with details on those conditions signed by both parties.

The Contractor shall provide the Ministry's Water Resources Development Dept. with soil samples taken at 3m intervals in the well, some water samples, well conditions, static water level, production capacity, etc

The Ministry may supervise and inspect the well drilling contractor's operation to check his compliance with these rules and specifications.

The Ministry shall decide in any disputes pertaining to the drilling operations.

Both parties shall sign this permit (in 1 original and 3 copies) and each party shall retain one of the copies; the third copy shall be filed with the concerned Ministry Branch or Dept. Branch. This Permit will be valid until the contractor starts working by it, or for three years from its date.

Director General, Water Preservation Dept.
___________________________
Signed

cc:
the drilling permits file with the complete file
the applicant
the contractor
the outgoing mail for reference.

The Supervisor

The Contractor

The land Owner

_____________________

_____________________

_____________________

Signed

Signed

Signed

5. LICENSING OF WELL DRILLERS

5.1 Granting of licences or registering as a well driller

Step One - Applying to be Registered as a Driller or for a Driller's Licence

III - AUSTRALIA - NORTHERN TERRITORY - Water Regulations, 1999

FORM 16

Regulation 10(1)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

APPLICATION FOR DRILLING LICENCE
Pursuant to section 49 of the Water Act

Application No......... (office use only)

Application for (tick relevant box)

Drilling Licence Class I
Drilling Licence Class II
Drilling Licence Class III
Renewal of Drilling Licence
Variation to the Drilling Licence

Name of Applicant:........................................................................................................
(surname) (given names)
Date of Birth:.................................................................................................................
Postal Address:..............................................................................................................
Post Code................................. Phone No....................................................................

NT Drilling Licence No. (if held)..................................................................................
Licence(s) held in other States of Australia...................................................................
.........................................................................................................................................
Current Employer..........................................................................................................
Postal Address...............................................................................................................
Post Code................................ Phone No....................................................................
OR
If self-employed - trading as.........................................................................................
(Company name)
Postal Address..............................................................................................................
Post Code............................ Phone No........................................................................

Approximate number of bores drilled during past three years
Class I..................... Class II........................ Class III...............................................
Under Supervision: Yes/No
Localities where drilling has been carried out............................................................
.....................................................................................................................................

Types of Drilling rigs currently being operated or operated during past three years -

Rotary Mud

Rig Make........

Capacity (M)........

Rotary Air

Rig Make........

Capacity (M)........

Reverse Circulation

Rig Make........

Capacity (M)........

Cable Tool

Rig Make........

Capacity (M)........

Other (specify)

Rig Make........

Capacity (M)........

Variation applied for
...............................................................................................................
...............................................................................................................

I declare all the above information is correct in every particular.

Applicant's Signature...........................
Date......................

Note: It is the responsibility of the applicant to supply whatever information he/she considers necessary to fully support the application for licensing.

To: The Controller of Water Resources
(address)

EXPLANATION OF CLASS

CLASS I This licence is restricted to drilling operations in single non-flowing aquifer systems.

CLASS II This Licence, in addition to operating in Class I conditions, permits drilling in multiple non- flowing aquifer systems.

CLASS III This Licence, in addition to operating in Class II conditions, permits drilling operations in flowing aquifer systems.

___________________________

IV - JAMAICA - Water resources regulations, 1995

FORM E

(Regulation 19 (1))

(To be completed in duplicate)
Application No...................

THE WATER RESOURCES ACT
APPLICATION FOR WELL-DRILLER'S LICENCE

1. Name of Applicant..........................................................................................
2. Address of Applicant......................................................................................
3. Date of birth....................................................................................................
4. Educational background..................................................................................
.............................................................................................................................
5. Indicate specific training relevant to well-drilling..........................................
.............................................................................................................................
6. Indicate specific experience in well-drilling...................................................
.............................................................................................................................
7. Are you self-employed?.................................................................................
8. If not self-employed:
Name of Employer.............................................................................................
Address of Employer..........................................................................................
How long employed by present Employer?.......................................................
9. State names and addresses of two references.................................................
............................................................................................................................
............................................................................................................................

Note:

Completed forms must be accompanied by:

(a) such documents or information as the Authority may require: and
(b) the relevant fee.

I hereby apply for a well-driller's licence pursuant to the Water Resources Act and declare that to the best of my knowledge the above particulars are true and correct.

I further declare that I am able to read and to make written reports on any well-drilling activity which I might undertake.

...........................................................

............................

Signature of Applicant

Date

____________________________________
(To be completed by the Secretary of the Authority)

Indicate whether application granted or refused.....................................................
Date of grant or refusal...........................................................................................
.................................................................................................................................
.................................................................................................................................
If application refused, reason for refusal................................................................
.................................................................................................................................
.................................................................................................................................

........................

.............................

Date

Secretary.
Water Resources Authority.

Step Three - Formatting of licences

I - CAYMAN ISLANDS - Water Authority Regulations, 1985

Schedule 1
Well Driller's Licence

1. Licence No.
2. Licence Holder:
3. Address:
4. Date of expiration:
5. Fee:Paid:

This licence is granted subject to the provisions of the Water Authority Law No. 18 of 1982, and the special conditions specified.

Failure to comply with the provisions of the Law, or with the terms and conditions of this licence may result in the penalties specified in section 51(1) and (3) of the Law, and the modification or revocation of this licence.

Date:

Signature and Seal of Authority:

III - JAMAICA - Water resources regulations, 1995

FORM F

(Regulation 19 (3))

Licence No........

THE WATER RESOURCES ACT
WELL-DRILLER'S LICENCE

................................................................................................................................. Of
......................................................................................................................................
(Name of Licensee) (Address of Licensee)
......................................................................................................................................

is hereby granted a licence to practise as a well-driller, subject to the provisions of the Water Resources Act and Regulations made thereunder and to such terms and conditions as may be specified herein.

The licence shall be valid for a period of.............................. from the date hereof, subject to the provisions of the Act and regulations relating to its revocation and suspension.

Terms and Conditions of Licence (if any)
......................................................................................................................................
......................................................................................................................................

Dated this day of 19

Seal

..................................................
Secretary.
Water Resources Authority.

IV - UGANDA - Water Resources Regulations, 1998

SIXTH SCHEDULE
THE REPUBLIC OF UGANDA
THE WATER STATUTE, 1995
The Water Resources Regulations, 1998

FORM F2

Regulation 19 (1) (2)

DRILLING PERMIT
To be completed in triplicate (3)

Permit No...............................................................................................................
Name and Address.................................................................................................
You are hereby authorised to operate the business of constructing boreholes in the following districts of Uganda:..................................................................................................................
This permit shall be valid from (date).................. to (date)....................................
In addition to the conditions specified in regulations 21 and 22, this permit is subject to the following conditions:

1..............................................................................................................................
2..............................................................................................................................
3..............................................................................................................................
4..............................................................................................................................
5..............................................................................................................................
6..............................................................................................................................
Date:.......................................................................................................................

Signature

Official Stamp

..........................................
Name
Director of Water Resources

___________________________

V - AUSTRALIA - NORTHERN TERRITORY - Water Regulations, 1999

FORM 17

Regulation 10(2)

NORTHERN TERRITORY OF AUSTRALIA
Water Regulations

DRILLING LICENCE
Pursuant to section 49 of the Water Act

LICENCE NO..............................
CLASS:........................................
(see reverse for explanation)
EXPIRY DATE:..........................

Subject to the provisions of the Water Act, Regulations and the following terms and conditions, a Drilling Licence is granted to...................................................... of:...................................................................... for drilling by method(s) shown hereunder:
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................

Terms and Conditions

1. All drilling shall be undertaken in accordance with sound drilling practices.

2. If in the course of operations on a bore a situation arises which causes the activity to move beyond the bounds of the particular Drilling Licence held by you, you shall immediately advise the Controller of Water Resources and further only continue operations under supervision of a suitably licensed person or as otherwise directed by the Controller of Water Resources.

3. Records and samples shall be retained and provided as set out in regulation 11 of the Water Regulations.

4. The following specific conditions will apply -

Controller of Water Resources
Date:........................................
Signed:....................................
Licensee

Note: Every application for a reissue of a Licence shall be made not later than one calendar month prior to the date of expiry of this Licence.


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