Title Page

Tū te Manawa 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 work area

Fencing

  • Fencing

  • Type of fencing

  • Length (m)

  • Rate/m ($)

  • More fencing

  • Type of fencing

  • Length (m)

  • Rate/m ($)

  • Total fencing cost ($)

Plants

  • Plants

  • Number of plants required

  • Average cost per plant ($)

  • Estimated plant purchase cost ($)

  • Cost per plant for planting and spot spraying

  • Cost of planting and spot spraying ($)

  • Suitable plant species

  • Total planting cost ($)

Other

  • Other

  • Total cost of other ($)

  • Other costs

Total Estimated Costs

  • Total estimated cost (excl. GST)

  • Grant rate (%)

  • Estimated grant (excl. GST)

Technical Criteria and Justification of Work

  • Farm type

  • Water management zone

  • Catchment/Stream Name

  • Justification of work

Risk Management

  • 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 while onsite and will be available if there is an emergency? (I.e. Cell phone coverage, VHF, UHF, PLB, mobile data).

Declaration

  • I hereby understand that the payment of funds is dependent upon the competition of the work in accordance with the summary noted above. I have fully participated in risk management discussions and will undertake actions outlined above. 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. I understand that any work undertaken prior to notificaion of financial approval is done at my own risk.

  • Signature of Applicant

  • Signature of Environmental Management Officer

Administration

  • Signature of Manager

  • Job Number

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