The land of the Dancing Deer

 

BACK

Sold to : Sl. No. ……………

Cashier,
Bishnupur PHE Division.


                  APPLICATION FORM FOR WATER SUPPLY CONNECTION.


1. Name (Individual/Office/Institution) :-
2. Father’s 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.