ULHASNAGAR MUNICIPAL CORPORATION CITIZEN FACILITATION CENTRE SUBJECT:- PERMISSION FOR DRAINAGE CONNECTION Token Number (For Office Use) Date:- / / (If Citizen Identification Number is given, do not fill below Details) Applicant's Details: Last Name/ Surname Name Father/Husband's Name Details of Society (If Application from Society): Name Of Society: Designation Address: Head Information House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: Ward Committee No.: 1 [ ] 2 [ ] 3 [ ] 4 [ ] Electrol Panel No.: Telephone No. (if any): Contact Person: Email Address (if any): Information of Property: Head Information Type of Property (Please Tick [?] as applicable) [ ] Land [ ] Building Property Number (Computerized) Name of Original owner Name of the Power of attorney holder (if any): Town/City: Taluka: Survey/Block/Barrack No.: C.T.S. No.: Part No./Sheet No.: Plot No./Unit No.: Citizen Identification Number Necessary Particulars about above service: Head Information 1 Address of Property Pin Necessary Enclosures related to above application are enclosed as under. (Please tick [ ? ] for YES or tick [?] for NO) Enclosures Yes/No 1 Xerox copy of Building permission and plan approved by UMC [ ] 2 Location map for drainage arrangement duly signed by license plumber [ ] 3 Latest receipt of tax bill paid (For Old Construction) [ ] Declaration I/We................................................................................................. state on solemn affirmation that the above information is true and correct to the best of my/our knowledge. If the information given is found wrong then I/We shall be held legally liable for its consequences. I/We am/are agreed to terms and conditions of corporation for above permission. Date:- Applicant's Signature ( ) The document may please be delivered to: 1. Self/Nominated Person [ ] a) C.F.C. [ ] b) Camp No. [ ] Name of Nominated Person (________________________________________________) 2. By Post a) U.P.C. [ ] b) Register A.D. [ ] 3. Courier [ ] (Not to be filled if address is same as above) Correspondence Address:- Last Name/ Surname Name Father/Husband Name House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: Email Address (if any):
