Schedule-6
(Related to Rule 14)

License to utilize the source
License No.:- …….
Shree…,
Sir/Madam,
This license has been issued to you to utilize the drinking water source in the
following manner-
1. Name and Address of licensee: – ………
2. Objectives of source utilization: – …………
3. Area to utilize the sources:-……..
4. The quantity of water to be utilized by source:-………..
5. The starting time to utilize the source:-…………..
6. Duration of the license:-…….
7. The terms to be obeyed by the licensee:-
a)
b)
c)
d)
Applicants:-
Signature:-
Name:-
Designation:
Office:-
Date:-