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Formforwaterconcetion 1

This document contains an application form for a new water/sewer connection. It requests personal information about the applicant such as name, address, and caste. It also requests details about the property like the street name, block number, and number of taps required. The licensed plumber who will do the work is named. Instructions note that the application must come from the house owner or authorized person. Office remarks section notes that the connection is sanctioned pending compliance with rules by the water supply section.

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92 views3 pages

Formforwaterconcetion 1

This document contains an application form for a new water/sewer connection. It requests personal information about the applicant such as name, address, and caste. It also requests details about the property like the street name, block number, and number of taps required. The licensed plumber who will do the work is named. Instructions note that the application must come from the house owner or authorized person. Office remarks section notes that the connection is sanctioned pending compliance with rules by the water supply section.

Uploaded by

api-3829613
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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Municipal Corporation/Council

Water Supply Section, _________


FORM
APPLICATION FOR WATER/ SEWER CONNECTION

To,
The Corporation Engineer Water Supply
Municipal Corporation/Council,
_______________________.
Sir

I want to have a New Water/Sewer Connection in my house I,


__________________________________ have read the rules and regulations of the
Water Works Department, Patiala and do under take to abide by them.
Agreement Form “B” supported by Twelve annas stamp in attached
herewith duly signed by me.
The Particulars are given below:-

Name of Mohalla : _________________________________

Street : _________________________________

Block No : _________________________________

Name of house owner : _________________________________

Father’s Name : _________________________________

Cast : _________________________________

Name of applicant : _________________________________

Father’s Name : _________________________________

Cast : _________________________________

Size of ferule : _________________________________

No. of taps required : _________________________________

Lower Story : _________________________________

Upper Story : _________________________________


Name of the licensed plumber
through whom the work will be __________________________________________
executed.
INSTRUCTION Signature of applicant:________________________
The application should be
entertained either from the house Father’s Name :_______________________________
owner of such person who has Cast :______________________________
been authorized to do so by the Full Address :______________________________
house owner and is held
responsible for the payment of Date :______________________________
water charged etc. Other on cash
security.

OFFICE REMARKS

Sanction is hereby accorded to release the Water Connection and the application is
forwarded in original to the Water Supply Section for compliance under the rules.

Municipal
Commissioner/Executive Officer,
Municipal Corporation/Council,
_____________________.

Forwarded in original to the ______________________ (Name of the licensed


plumber) and for report after the completion of the work under rules.

Municipal
Commissioner/Executive Officer,
Municipal Corporation/Council,
_____________________.

The application is returned in original after completing the work under


rules for opening the water perting the bore in the pipe line.
(Signature of the licensed plumber)

I certify that work has been completed according to the Water Works
rules and__________ inch bore has been made in the pipe line in my presence at
(time and date)________________.

(Signature of S/O In-charge)

I certify that the water Connection has been entered in the ledger at
No.______ and the supply of water has been commenced at time________ on(date)
________ after receiving the Boring fee Rs.__________ and Water Charges
Rs._______ from ( date)________________ to (date)____________ Receipt
No.____________________(date)
Book No___________________________.

(Signature of Ledger Keeper)

The application is returned in original to Municipal Commissioner/Executive Office


after compliance under the rules.

Signature of S/ O In-charge,
Municipal
Corporation/council,
____________________
____.

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