The Chief Executive Officer, Form: WRA 001A

Water Resources Authority, Basin Area:

P.O. Box 45250 – 00100 WRA ID:
NAIROBI File No
Water Resources Authority

Grid Reference for Works (UTM Arc 1960)

Easting:
Northing:
Zone:

APPLICATION FOR WATER PERMIT

(To be submitted in triplicate) (Regulation 7, 13, 15,16,51,52)
Type of Surface Water Groundwater Effluent Swamp
Water Discharge Drainage
Use Diversion Abstraction In-stream Storage Shallow Borehole
Works well
Tick Box
Attach 1B 1B 1B 1C 1D 1D 1E 1F
Form

PARTICULARS OF APPLICANT DETAILS

1. Full name of applicant(s) (In Block Letters)
2. Category of Applicant - Individual, Group
[Association, Society], Company, Institution
3. ID Number of Applicant (Individual) or Certificate
of Incorporation or Registration for Groups or
Companies
4. PIN Number (where available)
Physical Address where water is to be used Contact Address of Applicant
5. L.R Number(s) 12. Box Number
6. Village(s)/ 13.Town
7. Sub Location 14. Post Code
8. Location(s) 15. Telephone Contact (Landline)
CountyLocation(s)
9. Division/Ward(s) 16. Telephone Contact (Mobile)
10. Sub County 17. Email Contact
11. County

WATER RESOURCE DETAILS

18. Name of Body of Water or Aquifer where water is to be
diverted, abstracted or stored
19. Is the point of abstraction or storage in a Protected Area or
a Groundwater Conservation Area? (yes/no)
20. Sub-Basin Number
21. Class of Water Resource
22. Name of Body of Water or Aquifer where effluent is to be
discharged
23. Sub-Basin (Effluent)
24. Class of Water Resource (Effluent)
25. Category of Application (Class of Permit)

MIXING WATERS
25. State
26.
MIXINGDoes the
applicant own all theand
authorization(s)
WATERS land relatedalready
permits to the permit application? Yes/No
issued in
respect
26. If No,
of the
have
water
easement(s)
use on thebeen
landattached
described(Yes
in =
No.
1, 4.
no(If
= 0)
NIL,
state “Nil”,application
27. Does if YES, listinvolve
authorisation or permit
land located withinnumbers).
or adjacent to a riparian, protected or groundwater
conservation area? Yes/No
Note:
28. IsShaded
proposedAreas to bepermitted
activity filled in by WRAthe
within Officials
riparian area, protected or groundwater conservation area?
Yes/No
OWNERSHIP OF WORKS
29. Will the applicant own all the works related to the permit application?
30. If No, have agreement(s) been obtained from owner(s) of all works and these agreements are adequate
and are attached (Yes/no)
SUPPLEMENT TO PERMIT/AUTHORISATION
31. Is application made under section 21 of WRA Regulations? Yes/No
32. Provide Permit Number for Main Permit
 The Chief Executive Officer, Form: WRA 001A
Water Resources Authority, Basin Area:
P.O. Box 45250 – 00100 WRA ID:
NAIROBI File No
Water Resources Authority

LAND
27. Does applicant own all the land related to the permit application? Yes/No
28. If No, have easement(s) been attached (Yes = 1, no = 0)
29. Does application involve land located within or adjacent to a riparian, protected or groundwater
conservation area? Yes/No
30. Is proposed activity permitted within the riparian area, protected or groundwater conservation area?
Yes/No
OWNERSHIP OF WORKS
31. Will the applicant own all the works related to the permit application?
32. If No, have agreement(s) been obtained from owner(s) of all works and these agreements are adequate
and are attached (Yes/no)
SUPPLEMENT TO PERMIT/AUTHORISATION
33. Is application made under section 21 of WRA Regulations? Yes/No
34. Provide Permit Number for Main Permit

QUANTITY WATER REQUIRED

35. Brief Description of Project
and Intended Use for Water

Type of Water Use Groundwater Surface Water (m3/day)

(m3/day) River - Normal River - Flood River- Regulated Lake
Condition Condition Flows
36. Public
37. Domestic
38. Livestock
39. Subsistence Irrigation
40. Commercial Irrigation
41. Industry/Commercial
42. Hydropower
43. Others
44. Sub-total
45. Quantity Returned
46. Water Used (row 44-row 45)
47. Effluent Discharge
PERIOD OF CONSTRUCTION
48. State the estimated period of construction of the works (months)

49. State the period for which the permit is required (year – maximum 5 years)
 The Chief Executive Officer, Form: WRA 001A
Water Resources Authority, Basin Area:
P.O. Box 45250 – 00100 WRA ID:
NAIROBI File No
Water Resources Authority

DESCRIPTION OF WATER USE

DOMESTIC
Population to be served (number of people)
Basic Human Needs (m3/day)
Domestic Water Demand (m3/day)

LIVESTOCK
Type of Livestock Number of Animals
Number of Grade Cattle
Number of Local Cattle or donkeys
Number of goats & sheep
Number of camels
Other
PUBLIC PURPOSE
Supply Area (km2)
Population to be served
SUBSISTENCE IRRIGATION –Water for Household Food Security
Number of connections
Area per connection (ha)
Total Irrigated Area (ha)
Expected Rate of Water Use m3/ha/day
Total Expected Water Requirements (m3/day)
COMMERCIAL IRRIGATION
Type of Crop (hectares) Type of Production Type of Irrigation Expected Rate of Water Total Expected Water
System (Outdoor, Technology (overhead, Use m3/ha/day Requirements (m3/day)
GH, hydroponics) micro-sprinkler, drip)

TOTAL
INDUSTRIAL
Number of Persons Employed
Type of Industry (tick whichever is appropriate)
Food Processing Pulping (Coffee, sisal, sugar,)
Horticultural Packaging Tea
Chemical Manufacturing Bottling
Tanning Others (state type)
Water Requirements
Water required for Plant/Processing (m3/day)
Water required for Sanitation Facilities (m3/day)
Water required for other purposes (m3/day)
Total Water Requirements (m3/day)
POWER
Maximum static head (m)
Expected Power Generated (KVa-hr) at Maximum Static Head
OTHER USES
Fishponds (volume – m3)
 The Chief Executive Officer, Form: WRA 001A
Water Resources Authority, Basin Area:
P.O. Box 45250 – 00100 WRA ID:
NAIROBI File No
Water Resources Authority

FEES SUBMITTED
Category A, B, C or D Application Fees for Examination of Application
AMOUNT PAID
Receipt Number

ATTACHEMENTS Attached (Yes/No) Comments/Remarks

Form 1B
Form 1C
Form 1D
Form 1E
Form 1F
Copy of Identification Documents
Copy of Land Documents
Copy of Agreements on Land Use
Copy of Agreements on Use of Water Works
Relevant Maps
Copy of EIA License
Site Assessment Report
Technical Reports
Hydrological Assessment Report
Hydrogeological Survey Report
Technical Design Report
Dam Design Report
Effluent Discharge Control Plan
Soil and Water Conservation Plan
Copy of Receipt for Payment
WRUA Comment Form
I agree to supply any further information which may be required by the Water Resources Authority

SIGNATURE………………………………………….
Signature of Applicant or duly Authorised Agent

Name

Date of Application

SIGNATURE OF WRA OFFICIAL RECEIVING APPLICATION

Signature of WRA Official

Name

Position

Date Application Received

 The Chief Executive Officer, Form: WRA 001A
Water Resources Authority, Basin Area:
P.O. Box 45250 – 00100 WRA ID:
NAIROBI File No
Water Resources Authority

OFFICIAL SECTION
(To be filled in by WRA Officials)
Tick Date Officer
Submission
WRUA comments received
Recommended
Rejected
Conditional Recommendation
BWRC advice received
Recommended
Rejected
Conditional Recommendation
WRA National Office
(Category D)
Recommended
Rejected
Conditional Recommendation
WRA Basin Area Office
Recommended
Rejected
Authorisation
Issue of Authorisation
Validity Period (months)
Expiry
Extension of Validity Period
(months)
Revised Expiry Date
Inspection of Final Completion
Date of Issue of Permit
Date of Expiry of Permit