HIMACHAL PRADESH IRRIGATION COM PH DEPARTMENT

ISSUED TO SH./SMT………………………………………………………………….......
...............................................................................................................................................
Assistant Engineer,
IPH/STP Sub Division
…………

APPLICATION FOR NEW SEWERAGE CONNECTION DOMESTIC/COMMERCIAL

Application
No…………………
To

Executive Engineer,
IPH/STP Division,…………………..

(1) Name of Building ………………………………………………………………………….

(2) Place ………………………………………………………………………………………..
(3) Year of Construction ……………………………………………………………………….
(4) Name of owner of Building along with Khasra No. ……………………………………….
(5) Whether Building is complete or partly complete …………………………………………
(6) Sanction no. of Completion Plan …………………………………………………………..
(7) Name of Person in whose’s
(a) Name of Water Connection exists ……………………………………………………
(b) Water Connection No. ………………………………………………………………..
(8) Whether Building is located in the limits of Urban Local Bodies OR Out Side Urban
Local Bodies Limits:………………………………………………………………………..
(9) No. of Dwelling Units in the Building :………………………………………………….
(10) No. of User’s (Approx.)………………………………………………………………….
(11) Detail of WC’s: (a) Indian Type: ………………………………………………………..
: (b) Orissa Pan ……………………… ( c) Suropean Type ……………….
(12) No. of Bathrooms : …………………………………………………………………………
(13) No. of Kitchens : …………………………………………………………………………...
(14) Details of Existing Fittings ………………………(ii) Taps ……………………………….
(15) Address for Correspondence (along with Phone No. if any): ……………………………...
 ………………………………………………………………………………………………
(16) Permanent Address : ……………………………………………………………………….
……………………………………………………………………………………………..
(17) Signature of Applicant :…………………………………………………………………….
(18) Date of Submission of Application : ……………………………………………………….

For Office Purpose only

Recommended of Junior Engineer Verified dwelling units having : ………………………………

Kitchen:……………………………………….
Toilets:…………………………………………
Bath:……………………………………………
Contributing to Sewerage/ Sullage in respect of building
Of:………………………………………Khasra No…… ……………………….. Located in
Sewerage ………………………….. Zone, A sewerage connection is commended for sanction
after fulfilling other codal of formalities.

Signature Signature
(Name…………………………………) (Name…………………………………)

Junior Engineer Assistant Engineer

One number Sewerage connection of size……………………... as per NOC from Urban Local
Body……………….…./Town and country planning department Shimla is hereby sanctioned in
faour of ………………………………………………………………….
Having Water Connection No. …………………………… subject to deposit Sewerage Security
@ Rs. …………………………………. And fulfilling of codal formalities as per sanction letter
This connection is signed Account Number SNC-1/2006………………………………………..

Signature of sanctioning authority with seal