ANNEXURE- I

APPLICATION FOR SUPPLY OF WATER

 The Executive Officer.
                    Town Panchayat.

                                        Date of Receipt:
                                        Sl.No.:
                                        Requested to contact
                                        on:

          I,..................................................... Owner/Occupier  of the under noted building hereby  request  that you  will  arrange  to  supply me  with  water  for  domestic/non domestic purposes in house No........................ Street. The  domestic/non-domestic purpose referred to is................  and the  quantity of water likely to be consumed for such purpose  is   ..............................  litres per day  I agree  to  pay charges  at  the  rates specified in this  bylaws.     I  further undertake  to pay the meter rent and for maintenance  charges  as fixed  in the bylaws.  In the event of my desiring  to  terminate water supply arrangement herein provided for I undertake to  give a  month's notice in writing to the Executive Authority  to  that effect.

      Encl:                             
                                   Signature of the Owner/ Occupier of the premises.

                                   Address:

ACKNOWLEDGEMENT. 

                                                                                        Office of the Town Panchayat,

                                                                                         Sl.No.         Date:

                Received the application for supply of water  from Thiru..................  He is requested to contact the Executive Officer regarding the disposal of application on.......(after  30 days)   You  are assigned seniority No........  as  per  register maintained for this purpose.

                                                                        Executive Officer,Town Panchayat.