Form Ssa/Pdc/3

FORM WSIA/PDC/8

WATER SERVICES INDUSTRY ACT 2006

WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC TANK) RULES 2013

NOTICE OF FINAL INSPECTION

To: Sewerage Certifying Agency

I/We hereby give notice that the sewerage works hereafter described and now in the course of construction at:

CADANGAN MEMBINA SEBUAH BANGLO 2 TINGKAT DENGAN 1 TINGKAT DI BAWAH ARAS TANAH TERBUKA DI ATAS NO. 9, LOT 33516, JALAN BRP 2/2D, BUKIT RAHMAN PUTRA, SEKSYEN U20, 40160 SHAH ALAM, SELANGOR DARUL EHSAN UNTUK KPG PADU SDN. BHD. has been completed and is ready for final inspection.

Description of sewerage works:-

A. I/We hereby declare in accordance with the Statutory Declaration Act 1960 that the sewerage works has been constructed under my/our supervision and to the best of my/our knowledge,the work has been constructed in accordance with the approved sewerage planning and approved design and the Water Services Industry ( Planning,Design and Construction of Sewerage System and Septic Tank) Rules 2013.I/We accept full responsibility for the sewerage works.

B. I/We hereby declare and agree that all relevant records of the sewerage works testing carried out by me/us will be duly submitted to the Sewerage Certifying Agency upon the completion of the testing.

Signature of Competent Person Signature of Competent Person (Civil & Structural) (Mechanical & Electrical)

Name of Competent Person Name of Permit Holder (in block letters) : IR. HO CHEE KONG (in block letters) :

I.C. No : 661003-06-5597 I.C. No :

Address : MOK CONSULTING ENGINEER SDN. BHD. Address : NO. 1-6, BLOCK E2, JALAN PJU 1/42A, DATARAN PRIMA, 47301 PETALING JAYA, SELANGOR

Telephone No. : 03-7804 0188 Telephone No. :

Fax No. : 03-7804 0178 Fax No. :

E-mail address : [email protected] E-mail address :

SPAN Permit No. : FORM WSIA/PDC/8

C. I/We hereby declare in accordance with the Statutory Declaration Act 1960 that the sewerage works has been constructed in pursuant to the approved sewerage planning and approved design and Water Services Industry ( Planning,Design and Construction of Sewerage System and Septic Tank) Rules 2013.

______(Signature /Stamp) (Signature /Stamp)

Developer : Permit Holder :

Name :

Name : SPAN Pernit No. :

Developer’s Expiry date

License No. : of permit :

______

Fee details:

Type of payment : *Bank Draft/Government Cheque

Issuing Bank :

Date :

Amount :

Cheque no. :

Validity :

(Notes:* delete where appropriate)

FOR OFFICIAL USE ONLY

Receipt No :

Reference No. :