CALCUTTA MUNICIPAL CORPORATION APPLICATION FOR OBTAINING PRIVATE WATER SUPPLY CONNECTION under provisions of Section 235/236/239/260 of CMC Act Serial #____________________ Registration #_____________________ Date ______________________ For premises #____________________________________________________________________________ 1. Ward #____________________________________ Borough #___________________________________ 2. Name and address of owner/occupier _____________________________________________________ 3. Name of plumber and Licence # with date _________________________________________________ 4. Purpose: domestic/non-domestic _________________________________________________________ 5. Assessee # of the premises _______________________________________________________________ 6. Annual valuation _______________________________________________________________________ 7. Size of ferrule applied for ________________________________________________________________ 8. Enclosed three copies of printed blue or ammonia plans showing details ______________________ 9. Nature of connection ____________________________________________________________________ I declare that the information and statements I have included in this application are correct to the best of my knowledge and belief. Plumber's full signature Owner's/occupier's full signature with Licence # and date Date of application _______________________ Signed in my presence Office Order Inspector, Section/Ward__________________ Please deal with this application and report. Assistant Engineer, W.ater Supply Assistant Engineer, Water Supply Section__________________________________ Section _________________________________ Page 2 APPLICATION FOR OBTAINING PRIVATE WATER SUPPLY CONNECTION under provisions of Section 235/236/239/260 of CMC Act FOR OFFICE USE ONLY 1A. Report of Assessment Department 1B. Report of Inspector W.S/SAE, WS 2. Permission in granted to connect/extend/alter/change/shift/enlarge/utilise by means of following pipe and water fittings for conveying wholesome or unfiltered water to the premises in accordance with sanctioned plan subject to other terms and conditions noted here. 5. Amount to be deposited in advance: 3. Size and description of supply pipe_____________ a. Deposit money for non-domestic connection 4. Detail of water fittings b. Water charge___________________________ a. FV or LV ferrule size __________________________ b. FV or LV stop cock size _______________________ c. Water meter size _____________________________ d. Construction of SUG & OH reservoirs sizes ____________________ numbers ____________ e. Electric motors HP ______________________ numbers ____________ f. Check valve or reflux valves sizes_____________________ numbers ____________ g. Water taps sizes ____________________ numbers _____________ h. Flushing cistren sizes ____________________ numbers _____________ i. Any other fittings________Vir __________________ c. Water charge arrears, if any ______________ d. Water connection fee____________________ e. Road opening fee_______________________ f. Road Restoration fee_____________________ _________________________Rs _____________ _________________________Rs _____________ _________________________Rs _____________ _________________________Rs _____________ g. Miscellaneous fee, if any, Rs _____________ 6. BS plan #______________Date____________ 7. RO allowed on _________________________ Specific terms and conditions of the sanction/permission Assistant Engineer, Water Supply Executive Engineer, Water Supply Section________________________________________
