Deep Borewell Odisha Form – Fill Out and Use This PDF

To

The Executive Engineer,

Lift Irrigation Division,

(Through proper channel)

Sub: Application for installation of Bore Well in my land/plot under

Biju Krushak Vikash Yojana - Deep Bore Well Secha Kariyakram.

Sir,

I am to intimate you that I, Sri/Smt…………………………………………………………………….

S.O/W.O..………………………………………………..................... have my land at ……………………… village of

...................................... Block, under	.................................... District having plot No …………, Khata
No......................…… Area	hectare, where I want to have the installation of one Bore Well
under the above mentioned scheme.

I may kindly be allowed to deposit an amount Rs.1000/- (non-refundable) towards initial deposit, if my plot is found suitable to such installation, after pre-feasibility study by you, which will be subsequently subjected to VES test (Sounding Test).

Upon successful installation of Bore Well and yield test, I undertake to deposit my balance contribution of 10% of the project cost, maximum up to Rs.20000/-. Further, I shall facilitate necessary approach to the pin- pointed plot. I herewith offer my willingness to execute agreement with the electrical distribution company for availing power supply to the proposed Bore Well project after deposit of the Service Connection Charge, Security Deposit and Inspection fees etc. by me. After energisation, the project shall be taken over by me.

Enclosure:- Documentation Sheet

Yours faithfully,

Date:

Place:

Signature of the Applicant

Village-

G.P.-

Block:-

Telephone No.

For Office Use only

Application slno.

Dt.____ /____ / 201____

Signature of J.E.(C) OLIC

Acknowledgement

Received	one application from Sri/Smt	for installation of one Bore Well
under Biju Krushak Vikash Yojana-Deep Bore Well Secha kayakrama with serial No			date
............................

Signature of J.E. (C) OLIC