application form - howrah.gov.inhowrah.gov.in/forms/license/forms/binder1.pdfapplication form under...
TRANSCRIPT
POLICE STATION :
West Bengal From No. 393 Z (141
",: :: i . -,' .: ,' .:
APPLICATION FORMUnder Section 15 to the West Bengal Fire Service Act. 1950 (West Bengal ant XVilt of 1950)as subsequently amonded. read Government Notifiaction No.81 3lF2E-1.01/63 dt.23.2.65
under ection 23(1) of th€ Act.
To
The CollectorFire Licence (Licence Section)Howrah.
Sir,Under the provisions of section 15 of the West Bengal Fire Services Act, 1g50 (West Bengal
Act XVlll of 1950), as subsequentty amended. l/We beg to apply for neMrenewal Licences for my/ourwarehousp/workshopdeSclbqdb9low'fo1thepariodofopeyeqrwitheffeetformtheA plan (duplicate) of the warehouse/rriolkshop diawn'to the sbalb of one metre'to a centimeters, isannexed herewith.
Yours faithfutly,(BLOCK LETTERS)
Signature in Full :
Name in Full :
Address in Full :
Present :
Parmanent:
Date:
Number and date of last License issued, if any :
1. Ward No.
2. Premises No.
;i:, r:ii'ai : ,r:
.-*T4'- :Narne and maximum quantity of the article or each of the articles to be stored, pressed or kept
6. Name of owner of the building or place
7 . Name of occupiers with their office address
8. Annual municipal value of the werehouse/workshop or annual value as assessed by the
Collector
9. Description of structure and nature of occupancy with immediate 20 feet all round of the
proposed werehouse/workshop
10. Name of the insurance Company, lf the premises be insured
1 1 . Exact number of water / sand bucket and extinguishers provided on site and each indicated on
plans
12. Total floor area of the werehouse/workshop (each floor separately)
13.State water --
(i) Sprinkleris installed........;........ ..............:.
(ii) Hydrant system is installedi if so, give capacity of pump in gallons per minute and normalworking pressure and number of hydrants f itted ........,.,,....................,.......;........,......,....,...:.-...."..
(iii) Distance of nearest open water (i.e. river or tank) with access, details and approximate areand depth ...... ...........
..;......... ..........:'..'.'.::iir;::::.......::.............................:....tiS.rtgh+.t*,....,8t...kI*Ag.**-,