(l) TheArunochol Prodesh Woter SupplyAct, 2000 (Act No.
9 of 2000) is here by repeoled.
(2) Notwithstonding such repeol onything done or ony oction token under the soid Act sholl be deemed to hove been done or token under the corresponding provisions of this Act.
No- 49 FORM WS - | See Sub secton 3(2) (lXo) GOVERNMENT OF ARUNACHAL PRADESH PUBLIC HEALTH ENGINEERING DEPARTMENT AND WATER SUPPLY DIVISION Doted Woter suooly connection opolicotion form The Executive Engineer Public Heolth Engineering & Woter Supply Division To, Photo Sir, lMe request for your kind permission to ollow to drow woter {rom the Stote Government Moin(s).
lMe sholl be obide by the stonding rules, regulotion ond directives.
Yours foithfully, (Signoture of the Applicont) (To be filled in Copitol Letters) Nome/ Designotion of the opplicont Correct moiling Address House No. with locotion Nome of the Deportment/Orgonisotion if in service _ Woter is required for (Tick Mork)
(o) Drinking /Construction/ Foctory use /lnstitution / Commerciol/ Specify others uses _
(b) StoteGovernment/Privote/Centrol/Others
6. Detoils of premises (Tick Mork)
(o) RCC/Non RCC/ others -
(b) Nos o{ Storeys -
7. Period of woter supply requirement (Tick mork)
(o) Permonent / Temporory / Requirement for construction/ other uses I 2 3 4 5 50
8. User Detoils
(o) Nos. of Iomily unit
(b) Nos. of Users
(c) Nos. of Tops in the premises I . I / We hereby certify thot the obove informotion ore true ond ony subsequent chonges contemploted sholl be notified to the deportment fifteen doys prior to effecting such chonges.
2. I Me hereby fully ogree thot oport from other reosons prescribed in the Arunochol Prodesh woter supply Act 201 5. Woter supply connection moy be disconnected in the event Uwe violote ony rules or regulotion or foil to poy woter revenue.
3. I / we hereby declore thot I / we om / ore the owners / of the premises mentioned in the opplicotion ond entire liobility of poyment ofwoter chorges, dues ond fines sholl rest on me/us or on the person whomsoever/ the ownership / liobility if legolly tronsferred.
Signoture:
Applicont:
Heod of Deportment / Officer (in cose ol Government Agency) R OFFICE USE ONLY
(o) t l0 poid vide (sum to be deposited under the occount of heod' O2l 5'lvoter supply).
(b) Woter supply connection Register Ref No. _ Bill Clerk PHE & WS Division 5r FORM WS -[ See Sub-seaion 3(2) (ll) (o) GOVERNMENT OF ARUNACHAL PRADESH PUBLIC HEALTH ENGINEERING DEPARTMENTAND WATER SUPPLY DIVISION Woter supply connection Doto sheet :
l. Nome of consumer
2. Address
3. Woter connection register ref. No
4. Recommendotions:
(c) Size of supply pipe : _
(d) Lenqth
(e) Estimoted requirement per doy (fl Heod ovoiloble from connection point
(g) Size ond LD of Stote Moin
(h) Dischorge ovoiloble in Stote moin
5. Connedion Chorges:
(A) Term deposit Receipt to be drown in fovour of Executive Engineer, Public Heolth Engineering Deportment.
(i) Supply of moteriols {
(ii) Lobour chorge T
(iii) Restorotion Supervision chorges T
(iv) Security Deposit / Cost of Meter { _
(v) Other chorges ( to be specified) t Sub Totol (A) { (Rupees only (B) Chorges to be credited under heod -'O21 5"woter supply
(i) Connection chorges {
(ii) Other chorqes < _ SUB-TOTAL (A+B){ _ 52 (C) MONTHLY REVENUE ASSESMENT (os per woter supply Rule) t - (Rupees only N.B. if ossessment is done on the bosis of other foctors, seporote onolysis sheet should be ottoched.
6. Annuol mointenonce (if opplicoble) { (Rupees only.
7. Liobility of poyment of woter chorges owner / occupont ol premises :- Nome { _ (Rupees ) only.
9. Connection tobe corried out by the Deportment Junior Engineer Assistont Engineer Executive Engineer Address _
8. System : Meter system / Top System _ Annuol woter tox ossessment (if opplicoble) 53 FORM WS - III See sub-Section 3(3) GOVERT{MENT OF ARUNACHAL PRADESH PUBLIC HEALTH ENGINEERING DEPARTMENTAND I'VATER SUPPLY DIVISION To:
Subiect: Woter Supply Connection lntimotion Letter For Poyment Sir/Modom, Wth reference to your opplicotion dotedon the obove subiect, you ore odvised to deposit the following sum in the Stote Bonk of lndio, bronch, under the heod (s) noted below ond produce the receipt (s) in the office of the undersigned for {urther necessory oction:- l Temporory Deposit Receipl drown in fovour of Executive Public Heolth Engineering Division (A) (i) Supply of moteriols {
(ii) Lobour Chorges l_
(iii) Restorotion/supervisionchorges{_
(iv) Security deposit {-
(v) other chorges 7 (Rupees - ) only
2. Chorges to be credited under heod"02l5 Woter Supply" (B) (i) connection chorge{
(ii) Other chorges (to be specified) z Sub Totol (A) { Grond totol (A+B) t (Rupees- ) only 51
3. Pleose reod the detoil corefully:-
(o) Monthly ossessment (As per the Woter Supply rule) t (Rupees )only
(b) Annuol mointenonce cost (if opplicoble) (RupeesT )only
(d) Systems: /Top system/ detoi t<
(e) Annuol woter tox ossessment (if opplicoble) (Rupeest ly (0 Connection to be corried out by Deportment.
4. Other detoils
(o) size ofthe supply pipe:-
(b) Nos
(c) Length
(d) Heod ovoiloble from connection point:-
(e) size ond lD of Stote moi
(f) l.D of moin/distribution tonk;_ Yours foithfully
5. I hove reod the contents of this document. I fully ogree ond obide by the provision of the Arunochol Prodesh Woter Supply Act 201 5.
Signoture of Applicont
(c) Liobility of poyment of woter chorges ond woter tox owner occupier of premises Executive Engineer PHE &Ws Division No 55
(x) For officiol usc only:- Received poyment of (Rupees only vide B.R ond TDR i,lo: doE for a Billing Clerk,PHE & WS Division
7. lmportont : Applicont pleose Sign this document ond returi to the deportment olong with Bonk Receipt ond Temporor_ Deposit Receipt os indicoted vide (l ) ond (2) FORXT WS - tV See sub-Sedion 3(4) GOVERNMENT OF ARUNACHAL PRADESH PUBLIC HEALTH ENGINEERING DEPARTMENTAND WATER SUPPLY DIVISION Doted Consumer lndex No:
Permission of Connection With reference to Registrotion No permission is hereby gronted to Shri/Smt. fo:
___in connection to his premises o{ locored ot_ The connection should be completed within one month's timo from the dote o{ issue of this connection permission, for which the Assistont Engineer Woter S chorgefloxes will be levied doy-montr- yeo Executive Engineer PHE & WS Division _ 56 upply should be contocted. Woter Copy to:- 0)
(2)
(3)
(4) Shri/S Superintending Engineer, PHE Circle Assistont Engineer PHE & WS Sub Division Junior Enqineer PHE & WS Section -.
FORM WS - V See sub-Section 4 (4) GOVERNMENT OF ARUNACHAL PRADESH PUBLIC HEALTH ENGINEERING DEPARTMENTAND WATER SUPPLYDIVISION- NOTICE No Doted:- To:
Mr/Mrs/Miss Subiect:Woter SuDolv Consumer index number Disconnection notice With reference to the obove consumer index number our occount shows on outstonding omount of t (Rupees ) only lying ogoinst you on occount of woter chorge/toxes forthe period mentioned hereunder.
ln occordonce with Arunochol Prodesh Woter supplyAct. lt is necessory thot the woter chorges ond toxes ore required to be poid regulorly os 57 indicoted in the bills. Non poyment of the chorges etc, hos been viewed seriously by the Deportment ond you ore therefore directed to settle the outstonding dues immediotely within 15 doys from the dote of receipt of this notice. lf you foil to poy the dues within the time specified obove the Deportment sholl toke oction ogoinst you under the provisions of the Act.
Detoils:
Month yeor Executive Engineer PHE & WS Division I I
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