FORM WSIA/PDC/6-1 WATER SERVICES INDUSTRY ACT 2006 WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC TANK) RULES 2013 NOTIFICATION FOR CONNECTION TO PUBLIC SEWER (This notice is to be submitted at least 4 days before connection works to public sewer is made) To Indah Water Konsortium Sdn Bhd Address | hereby give notice that the connection works to public sewer will be made on the date, time and location as specified botow: Date (day/monthiyear) Time (amipm) Location | take full responsibilty to supervise the works in accordance to sound engineering practices and completed in accordance: to approved soworage planning and approved design in compliance with Water Services Industry (Planning, Design and Construction of Sewerage System and Septic Tank) Rules 2013 and the requirements of other relevant regulatory agencies. ‘Signature of Competent Person ‘Name of Competent Person {in block letters) f Le. No, Address ‘Telephone No. Fax No, E-mail addressFORM WSIAIPDCI6-1 | take full responsibilty to supervise the works in accordance to sound engineering practices and completed in accordance to approved sewerage planning and approved design in compliance with Water Services Industry (Planning, Design and Construction of Sewerage System and Septic Tank) Rules 2013 end the requirements of other relevant regulatory agencies, ‘Signature of Permit Holder Name of Permit Holder (in block letters) 1. No. Address Telephone No FaxNo. E-mail address ‘SPAN Permit No.