APPLICATION FORM FOR INDIVIDUAL WATER TAP CONNECTION FOR PRIVATE BUILDINGS IN RURAL AREAS To, The Executive Engineer P.H.E.D. A.P.W.D., Port Blair. Sir, Kindly provide an individual water tap connection in my House / premises on usual payment Necessary details are given below for favour of further action. 1 Name of applicant : ......................... (as per revenue records) 2 Father's Husband' Name : ......................... 3 Postal Address : ......................... ......................... ......................... 4 Survey No/Plot No. Location, : village as per revenue records (Proof to be attached Attested Xerox copies ......................... 5 Whether the building Plot where water tap connection required is owned by the : Yes/No applicant? 6 Whether the pipe connection required for residential Commercial purpose. : ......................... 7 Whether internal water supply installation done or not? : Yes / No 8 Whether road cutting is required? If so, obtain and attach road cutting permission form EE, P : ......................... H E D. APWD, Port Blair Length of pipe laid down from distribution branch to building Plot. Necessary cash memo for purchase of pipe may be : ......................... attached I have gone through the conditions laid down for extending water connection to private building/ plot and agree to abide the rules and regulations in force from time to time. Necessary piped water supply may be extended to the above said building / plot shall make regular payment of water charges as fixed by the Executive Engineer. Public Health Engineering Division, APWD Port Blair or the authority who is competent for providing water supply to the building / plot. Place:.......... Signature of applicant. Dated:......... FOR OFFICE USE ONLY Forward to the Assistant Engineer, Sub Division No... PHED. Garacharma, with ....... enclosures for information. He is requested to inspect the spot and send report. Executive Engineer PHED, APWD, Port Blair TO BE FILLED UP BY CONCERN JUNIOR ENGINEER a) Whether the application had obtain any individual water tap connection previously. If so give details : .................... b) Whether any Public Hydrant exists next by the plot. : .................... c) Whether the proposed pipe line from distribution branch to bldg/plot is passing through Govt. land : .................... d) Whether road cutting required : .................... e) From which branch line the ITC to be provided : .................... f) Indicate the existing branch line and road in the enclosed Revenue map : .................... g) Remarks : .................... Date: Signature of Junior Engineer Place: With date Remark by Assistant Engineer Date : Place CONDITION FOR PROVIDING INDIVIDUAL WATER TAP CONNECTION IN RURAL AREAS 1. The expenditure of external pipe line including fittings beyond the distribution branches and making connection with CI GI distribution branches shall be incurred by the individual concerned. 2. The Chamber should be constructed as per standard design for stop cock pipe line by the individual. 3. Arrangement for all materials including pipe, stop cock with lock and locking arrangements shall be made by you at your own expenses. Details of the same can be ascertained from the Assistant Engineer, Sub-Division No.. of the Division. 4. Place for giving connection shall be decided by the Engineer-in-charge. In case the pipe line is passing through private or Govt. land necessary clearance shall be obtained by you. In case road cutting, cost of reconditioning the road as assessed by the Executive Engineer, P H E D, APWD shall be deposited in advance, by you. th 5. Payment of the water charges at the rate enforced from time to time is to be made with in 20of every month in respect of water charges bill have been sent or not. In case of failure to deposit water charges every month, the water connection shall be disconnected with one any notice. The connection charge of Rs. 50/- (Rupees Fifty only) shall be payable in cast re-connection is decided to be given. 6. Tap connection will be for domestic purpose only keeping in view the extreme difficulty being faced to be individual. In case of any issue of water or use other than for domestic purpose the connection shall be disconnected without any notice. 7. APWD SHALL NOT BE RESPONSIBLE in case of inadequate pressure or non-availability of water at any time due to technical reason or otherwise. No deduction in water charges will be admissible in case of break down of water supply and water will be available only during restricted houses of supply as regulated by the authority concern and no overhead tanks are permitted for storage water. 8. In case you fail to adhere to saw stipulations made as above the department shall be at liberty to cancel this order or dis-connect the tap connection given to you. Signature of Applicant Executive Engineer Public Health Engineering Division A.P.W.D, Port Blair
