Schedule-3
(Related to Sub-rule (1) of Rule 10)
Application for the license to survey the source
Mr. /Mrs. Chairperson,
District water resources committee
I have applied to get the license for surveying of the drinking water sources,
mentioning the following details-
1. Name and Address of a body corporate:-………
2. Objectives:-…………
3. Name of the source intending to be surveyed:-…………..
4. Source situated, Zone:-………………. District:-………….. Village
Development Committee/Municipality:-…………Ward No.:-………….
5. The duration to operate the survey:-………
6. Estimated cost to complete the survey:-……………….
7. Other details:-……………..
8. Documents to be submitted with the application:-
a) The report of economic, technical and environmental assessment
related to surveying of the sources.
b) Map of the place to be surveyed.
c) One copy of constitution if the organization a body corporate.
d) Other required documents.
The details mentioned above are true, if proved false, I shall be liable for
the consequences.
Applicants:-
Signature:-
Name:-
Address:-
Date:-