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