DocumentsPDFCompleteClick Here & UpgradeExpanded FeaturesUnlimited Pages PUBLIC HEALTH ENGINEERING DEPARTMENT GOVERNMENT OF ORISSA FORM OF APPLICATION FOR WATER SUPPLY / SEWERAGE CONNECTION Rule 8 of the Orissa Water Works (Urban Local Bodies) Rules, 1980 - Appendix-I 1. Name of the plot owner or his / her : legal heir (IN BLOCK LETTERS) 2. Permanent Address : 3. Present address on which : correspondence can be made 4. Number and location of the plot. : 5. Holding number of the building : 6. Ward number in which the building : is situated 7. Category of the building (i.e. : Residential, Shop-cum-Residence, Shop, Hotel, Guest House, Restaurant, Tea Stall, Industries, Clinic, etc.) 8. For Water Connection Only. : (a) Temporary / Permanent (b) Whether any arrear water charges outstanding against the existing connection to the plot. (c) Size and No. of proposed over head tank if any. (d) Size and no. of proposed sump if any (e) No. & type of different fixtures proposed. 9. Whether temporary / permanent water supply / sewer connection to the plot was sanctioned previously. 10. If so, indicate the following (a) If water connection existing whether it is temporary or permanent. (b) No. and date of sanction. (c) Date of connection. 11. The name and full local address of the registered PHD Contractor under Govt. of Orissa through whom the work will be executed. 12. The length and diameters of the pipe line / sewer line proposed to be laid. (a) Certified that the above information are correct to the best of my knowledge. (b) I undertake to abide by the WATER WORKS RULES, 1980. Further, I shall be bound by any addition or alteration made in these rules by the Govt. from time to time. (c) I also undertake that in case no bill is received by me by 10th of any month it would be my responsibility to contact the SDO, PH, Rent Sub-Divn. or Offier-in-charge of Water Works to collect and pay up the up-to-date water charges bills of my plot by 20th of that month, failing which the said SDO shall have every right to disconnect the water supply until the dues are paid. Sl. No. Type of fixture No. sanctioned previously No. for which sanction sought Total (a) Tap (b) Shower (c) Cistern (d) Wash hand basin (e) Any other type of fixtures DocumentsPDFCompleteClick Here & UpgradeExpanded FeaturesUnlimited PagesEnclosed: (1) Drawing two nos. (2) Up-to-date Municipal holding receipt. (3) Any other document as may be required by the Department Full signature of the Owner of the Plot or his / her legal heir. Note: (i) Copies of approved building drawings in duplicate duly attested by any Gazetted Officer drawn to a scale of not less than one inch to eight feet shall have to be submitted along with the application form properly filled in. (ii) The holding number, ward number, plot number, lay out of the premises, proposed point of connection, length and diameter of the pipe / sewer lines and positions of the fixtures, inspection chambers DocumentsPDFCompleteClick Here & UpgradeExpanded FeaturesUnlimited Pagesand existing sewer lines and manhole drawings in indelible ink. The existing and proposed works should be differentiated by use of different colouring ink for references. (iii) The signature and name of the owner or his / her heir and of the registered PHD Contractor of the Govt. of Orissa should be furnished on the body of the drawings. (iv) The original approved building drawings will have to be submitted for verification and return. (v) Record-of-right of the applicant on the plot should be produced for verification. (vi) A non-refundable fee as mentioned below to cover the charges for scrutiny of plans and supervision by Government will have to be deposited. (vii) A non-refundable fee as mentioned below to cover the charges of scrutiny of plans and supervision by Govt. will have to be deposited. Category New Connection charges per each connection (non-refundable) Security deposit (refundable for buildings with Estimated cost above Rs.1.00 lakh & for others shall be governed by provisions of Clause-10 of Water Works Rule of 1980) Water supply connection Sewerage connection Water Supply connection Sewerage connection (a) Domestic Rs.3000/- Rs.1500/ Rs.60/- Rs.60/ (b) Institutional Rs.4000/ Rs.2000/ Rs.60/ Rs.60/ (c) Industrial Rs.5000/ Rs.2500/ Rs.60/ Rs.60/ (d) Commercial Rs.5000/ Rs.2500/ Rs.60/ Rs.60/ DocumentsPDFCompleteClick Here & UpgradeExpanded FeaturesUnlimited PagesFOR OFFICIAL USE ONLY Memo No. /dated, Submitted to the SDO, PH Rent Sub-Division / Officer-in-Charge. The estimated cost of buildings stands at Rs. only. Enclosed: (1) Drawing two nos. (2) Up-to-date Municipal holding receipt. (3) Any other document as may be required by the Department Sectional Officer / Officer-in-Charge P.H. Rent Section An amount of Rs. (Rupees ) only may be deposited by the party of SCRUTINY of plans and supervision by the Government. Enclosed: (1) Drawing two nos. (2) Up-to-date Municipal holding receipt. (3) Any other document as may be required by the Department (4) Money receipt - one no. Sub-Divisional Officer / Officer-in-Charge P.H. Rent Sub-Division Memo No. /dated, The party has deposited an amount of Rs....... only towards the scrutiny fee (vide receipts No.......... dated the .....) the application along with the drawings forwarded to the Sectional Officer No.... to report on the admissibility of sanction after scrutiny of plans and supervision at site. Enclosed: (1) Drawing two nos. (2) Up-to-date Municipal holding receipt. (3) Any other document as may be required by the Department (4) Money receipt - one no. Sub-Divisional Officer / Officer-in-Charge P.H. Rent Sub-Division Memo No. /dated, Resubmitted to the S.D.O., PH Rent Sub-Division / Officer-in-charge along with the scrutiny report as follows: DocumentsPDFCompleteClick Here & UpgradeExpanded FeaturesUnlimited Pages(a) There is no water supply / sewerage connection / already a temporary water supply connection to this plot. (b) The water supply connection is recommended to be given from the existing dia distribution / rising main. (c) The proposed sewerage line of the plot is recommended to be connected to the existing sewer. (d) There is no outstanding due against this plot on this day. Enclosed: (1) Drawing two nos. (2) Up-to-date Municipal holding receipt. (3) Any other document as may be required by the Department (4) Money receipt - one no. Sectional Officer / Officer-in-Charge P.H. Rent Section Memo No. /dated, Recommended for sanction Enclosed: (1) Drawing two nos. (2) Up-to-date Municipal holding receipt. (3) Any other document as may be required by the Department (4) Money receipt - one no. Sub-Divisional Officer / Officer-in-Charge P.H. Rent Sub-Division
