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APPLICATION FORM FOR WATER SUPPLY CONNECTION.
1. Name (Individual/Office/Institution) :-
2. Fathers name :-
(in block letter)
3. Full Address :-
4. Patta No./Dag No/Plot No :-
(a copy to the patta to be enclosed)
5.Ownership of the premises :-
6.Municipal/Town/Ward No. :-
7. Whether the application is having connection authorized/unauthorized :-
8. If authorized, give approximate month and year :-
9. If authorized give connection no. :-
10. If latest water rate cleared (clearance receipt no.) :-
11. If for fresh/ new connection, indicate :-
12. Whether authorized/ unauthorized/ new (Indicate the nature of use ) :-
13. Any other information :-
Dated :-
Signature of the
For office use only
applicant:
Connection No.
Receipt No.
..
Officer-in-charge.
GOVERNMENT OF MANIPUR
PUBLIC HEALTH ENGINEERING DEPARTMENT
FEASIBILITY REPORT FORM
FOR NEW HYDRANT CONNECTION
1. Name of the Applicant :-
2. Address :-
3. Patta No. :-
4. Reference No. & Date :-
5. Size of the nearest main :-
6. Application No. & Date :-
7. No. of feeder line connection :-
8. No. of connection(s) from the feeder line :-
9. Size of nearest feeder line :-
10. No. of the connection(s) from the main :-
11. Assistant of the main/feeder line from the purposing to install the water joint connection :-
12. Whether the applicant for number of his/her family is enjoying temporary or
un-authorised connection:-
13. If mentioned period enjoyed :-
14. Pressure Position :-
15. Recommendation of the Section Officer :-
Signature of the S.O
Remarks of the Assistant
Assistant Engineer,
Engineer.
Sub-Division No.
.Bishnupur
P.H.E. Division, P.H.E. Deptt.
Manipur.
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