Borewell

FORM -1 A (Rule – 6) Application for digging / drilling a well / borewell for agricultural and Drinking water use 1. Name of the Applicant 2. Address of the Applicant

: :

______________________________ ______________________________ ______________________________ ______________________________

3.Location of proposed borewell, Property
Khatha No. / ward no.

/

:

______________________________ ______________________________ ______________________________ ______________________________

(With complete address & RR No. of BWSSB water supply/sanitary connection if any) 4. Purpose of digging / drilling well/ Borewell (Agricultural/drinking water use) 5. Existing status of water supply And public borewell 7. Details of payment a) Survey Charges b) Copy of paid challan c) Branch of Canara Bank

: :

______________________________ ______________________________ ______________________________

6. Distance from existing functional well/borewell :

: : :

Rs. 50/-

______________________________ ______________________________

I hereby declare that the above particulars are true to the best of my knowledge and belief. Place Date : : Signature of the Applicant

Note: The amount of Rs.50/- shall be deposited at any branch of CANARA BANK, Bangalore to the current A/C No.0788201052332 and the copy of paid challan has to be enclosed with the application. _______________________________________________________________________________________ ACKNOWLEDGEMENT An application for digging / drilling a new well / borewell for agricultural / drinking water use is received in this office along with an application fee of Rs.50/- paid at ___________________branch, Canara Bank Dated______________ from Sri/Smt___________________________. Place Date

: :

Signature of Designated Officer Karnataka Ground Water Authority
1

FORM -1 B (Rule – 6) Application for digging / drilling a well / borewell for Industrial / Commercial, Entertainment or other