Subdivision or Industrial Connection- High-Level Application v1

Development Site Location

The site location is the legal parcel of land in which you require Counties Energy to supply an electricity connection.
Site address*

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Lot Number*
DP number (found on your title plan)*
Requester Information
Name of person completing this form*

First NameLast Name
Company name
Contact phone*

Area CodePhone Number
Email*
example@example.com
Anticipated usage of site*

SubdivisionCommerial - Glass house shedIndustrialSchool/Educational facilityFarm/OrchardPump supplyStreetlight (please attach a plan)EV ChargerOther
Number of Lots*
Capacity required per lot or single connection*

63amp (Standard residential)100A (Standard Commercial)Other
Site Plans

We must have an approved site plan submitted with this application, this must show any existing services that have been identified. These plans must have the subdivision proposed layout as well as any streetlight design plans.

Where possible please provide a CAD design.
Approved site plan (A3 PDF)*

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Declaration

As the legal owner of the property or as an authorised agent for the owner I hereby apply for a new or updated point of supply to the Counties Energy electricity network.

I confirm that I am duly authorised to sign this application and confirm that the Owner agrees to be bound by the terms and conditions as stated by Counties Energy Limited and hereby accepts all charges in relation to this application.
Owner name or authorised agent*
Date*

DayMonthYear
Date
Should be Empty:

Development Site Location

Requester Information

Site Plans

Declaration