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State of Goa - Section
Section 9 in The Goa Ground Water Regulation Rules, 2003
9. Permission to sink a well in non-Scheduled area.
| 1a. | (i) | Name of the Applicant | (Surname) | (First name) | (Middle name) |
| (ii) | Age in years | ||||
| (iii) | Father's/Husband's name | ||||
| (iv) | Full Address | ||||
| 1b. | (i) | State, Govt. body/Municipality//Panchayat/Community | |||
| (ii) | Full Address | ||||
| 2. | Name and address of owner of land, on which the well proposedto register exists, if the Applicant himself is not the owner ofthe land and in what capacity Applicant has applied | ||||
| 3. | Nature of Registration | New/Renewal | |||
| 4. | If renewal, reference to original registration | ||||
| 5. | Location of the well | ||||
| (i) | Survey number & sub-division number | ||||
| (ii) | Name of the land | ||||
| (iii) | Revenue Village/Village Panchayat | ||||
| (iv) | Taluka | ||||
| (v) | District | ||||
| 6. | Type of well | Open well/ dug well/ sunk well/ bore well/ tube well/ pond/dug-cum-bore well/ filter point/ collector well/ infiltrationgallery. | |||
| 7. | Details of the well | ||||
| (A) | Diameter/size of the well | ||||
| (B) | Depth of well (In case of dug-cum-bore well give details ofboth the open and bore well) | ||||
| (C) | Distance from the nearest well | ||||
| 8. | (i) | Year of construction | |||
| (ii) | Year of commissioning | ||||
| 9. | The device used for lifting the ground water | ||||
| 10. | Details of power supply | 1. Type of pump: centrifugal/ turbine/ submersible/ jet/compressor/ others2. Horse Power3. Pump capacityE.D. Power Supply Connection No. | |||
| 11. | (i) | Number of hours pumping per day | |||
| (ii) | Quantity of drawal of ground water per day | ||||
| (iii) | Total period of use in each year | ||||
| 12. | (i) | Purpose of which the ground water is being used | Domestic/ Hotel/ Industry/ Construction/ Irrigation/Agriculture/ Horticulture/ Commercial/other use (specify) | ||
| (ii) | Extent of area irrigated in ha. if purpose if forirrigation/agriculture/horticulture | ||||
| 13. | Details of services involved in case of State, Community,Municipality run water supply schemes. |