Title Page

  • Landowner

  • Job number

NGĀ PUNA RAU RANGITĪKEI Freshwater Grant Application Form

  • Type of Application Form

  • Environmental Management Officer

Applicant Details

  • Applicant name

  • Postal address
  • Telephone number

  • Cellphone number

  • Email address

Proposed Works

  • Year of proposed works

  • Location of works
  • Photo of area

Fencing

  • Fencing

  • Type of fencing

  • Length of fencing (m)

  • Rate/m ($)

  • More fencing

  • Type of fencig

  • Length of fencing (m)

  • Rate/m ($)

  • Total fencing costs ($)

Plants

  • Plants

  • Number of plants required

  • Average cost per plant ($)

  • Estimated plant purchase cost ($)

  • Cost per plant for planting and spot spraying ($)

  • Total cost for planting and spot spraying ($)

  • Suitable plant species

  • Other plants

  • Total planting costs ($)

Other

  • Other

  • Other costs

  • Total cost of other ($)

Funding Share of Costs

  • Funding share of fencing costs (TMORT/HRC/Landowner) ($)

  • Funding share of planting costs (TMORT/HRC/Landowner) ($)

  • Funding share of other costs (TMORT/HRC/Landowner) ($)

  • Percentage share of fencing costs (TMORT/HRC/Landowner) (%)

  • Percentage share of planting costs (TMORT/HRC/Landowner) (%)

  • Percentage share of other costs (TMORT/HRC/Landowner) (%)

Total Costs

  • Total cost share (TMORT/HRC/Landowner) ($)

  • Average percentage (TMORT/HRC/Landowner) (%)

Technical Criteria and Justification of Work

  • Farm type

  • Water management zone

  • Catchment /Stream name

  • Justification of work

Risk Management

  • Risks to proposed works, including pest plants and animals. Identify likely threats, outline who will control them and how (e.g. Weeds, pest animals, releasing of riparian plants, flooding).

  • Access to site (are there any risks involved in site access? I.e. Steep inclines, rough tracks, bridges)

  • Who is undertaking the work? (Are they qualified and/or experienced for the type of work to be done?)

  • What risks are they bringing onto the site? (I.e. Equipment, chemicals, heavy machinery)

  • What risks are there on the property that people coming onsite need to know about? (I.e. Waterways, unstable banks, animals, sprayed areas)

  • How will people coming onto the property be told about the risks? (I.e. Briefings, site safety plans, signage)

  • What communication options will stakeholders use onsite and will be available in an emergency? (I.e. Cellular coverage, VHF, UHF, mobile data, GPS, PLB).

Declaration

  • I hereby understand that the payment of funds is dependent upon the completion of the work in accordance with the summary noted above. Any alterations will be discussed and approved by Horizons and NPRR representatives. I have fully participated in risk management discussions and will undertake actions outlined above. I understand that any work undertaken prior to notification of financial approval is done at my own risk. I agree to maintain and manage the above works in a manner that will enable them to continue to meet the objectives for the grant provided.

  • Landowner

  • NPRR Project Manager / Executive

  • Horizons Staff Member

  • Horizons Co-ordinator / Manager

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