Form Pendataan 5 Pilar Stbm

RT :

 NO

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

LEMBAR MONITORING SARANA CUCI TANGAN PAKAI SABUN (C TAHUN 2016 DUSUN…………………………………….. DUSUN…………………………… ……….. DESA………………………… DESA………………………………… ……… RW : INDIKATOR ADOPSI CTP

NAMA KK

JML JIW JIWA

ADA SARANA CUCI TANGAN

ADA AIR

ADA SABUN

PS) …………

PAHAM CTPS !"#$  %&'#$'()*!+#, -#%.)-!"!'/!

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS M DUKUH…… DUKUH……………… …………………… ……………….. ……...DE .DESA… SA…………… …………………… …………………… ……………… ……

RT :

RW : Kepemilikan Jamban

NO

1 2 3 4 5 6  ! " 1# 11 12 13 14 15 16 1 1! 1" 2# 21 22 23 24 25

Nama $emilik Rumah

Jml KK

Jml Ji%a

Sumbe

+eher +eher an'sa BAB &emplun' &emplun' an'sa *' Numpa Sumur (anpa Sembaran Seha( )*ak Seha( sep), n' -ali sep), 'an (ank (ank

SYARAKAT (STBM) … TAHUN 2017

r Air Bersih

+ain0 B.r lain

S$A+ Sarana $en'el.laan $en'el.laan &T$S Air /inum Sampah

Ke*ap Air

T*k Ke*ap Air

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBA DUKUH………………………………...DESA……………………………

Kepemilikan Jamban

NO

RT  RW

+eher +eher Jml Jml an'sa Jml KK Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

BAB Numpan' Sembaran 'an

1 2 3 4 5 6  ! " 1# 11 12 13 14 15 16 1 1! 1" 2# 21 22 23 24 25 FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBA DESA GABUSAN TAHUN 2017

Kepemilikan Jamban

NO

RT  RW

+eher +eher Jml Jml an'sa Jml KK Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

BAB Numpan' Sembaran 'an

S&N RT12

54

#

2#

25

#

"

#

RT2  2

51

6

21

#

#

11

#

RT 32

42



11

2#

#

4

#

14

13

52

45

#

24

#

RT13

6

34

6

2!

#



#

RT23

"

34

!

33

#

5

#

RT33

61

1"

4

36

#

2

#

RT43

64

!

!

42

1

5

#

RT53

64

#

3

5"

#

2

2

344

"5

2"

1"!

1

21

2

RT14

!5

"

12

44

#

2#

#

RT24

5

3

22

2"

#

21

#

16#

12

34

3

#

41

#

RT1  5

""

#

#

!3

#

16

#

RT25

11#

#

1#

"#

#

!

2

RT 35

6!

1"

#

34

#

15

#

RT 45

65

15

1

23

5

5

#

4

2

1

4"

#

22

#

416

36

2!

2"

5

66

2

-WARAN

ON--ON-

N-/BA-

RT 5  5 RT65

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBA DESA GABUSAN TAHUN 2017

Kepemilikan Jamban

NO

RT  RW

+eher +eher Jml Jml an'sa Jml KK Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

BAB Numpan' Sembaran 'an

N-/BART5

!3

1"

#

52

#



5

RT!5

4

26

#

4

#

1

#

RT"5

"1

3

2

36

#

5

11

RT1#5

66

1"

15

1#

1!

4

#

RT115

62

22

1!

"

11

2

#

36

123

35

154

2"

1"

16

"2

15"

63

433

34

!5

1!

RT16

6!

#

4!

2#

#

#

#

RT26

6!

#

32

34

#

2

#

$KWON +OR

RT36

2

#

36

34

1

1

#

2#!

#

116

!!

1

3

#

$KWON K+ RT1

43

131

4

#

33

#

6

#

RT2

33

1#2



#

1!

#

!

#

RT 3

55

16

15

#

34

#

6

#

RT4  

5!

11

13

#

36

#

"

#

1!"

3"

#

121

#

2"

#

RT1!

52

1

#

41

#

1#

#

RT2!

51

1

6

2

#

1

#

RT3!

52

#

2

35

6

"

#

155

1!

!

1#3

6

2#

#

16"

1

#

152

#

14

#

2164

353

3#2

1213

42

23

2#

BA+ON-KA+

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBA DESA GABUSAN TAHUN 2017

Kepemilikan Jamban

NO

ukuh

+eher +eher Jml Jml an'sa Jml KK Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

BAB Numpan' Sembaran 'an

1 -abusan

16"

155

1

#

152

#

14

#

2 Su,en

14

14

13

52

45

#

24

#

3 -u%aran

344

344

"5

2"

1"!

1

21

2

4 .n''.n'

16#

16#

12

34

3

#

41

#

5 N'embak

"2

"2

15"

63

433

34

!5

1!

6 $ek+.r

2#!

2#!

#

116

!!

1

3

#

 $ekKi*ul

1!"

1!"

3"

#

121

#

2"

#

! Bal.n'kal

155

155

1!

!

1#3

6

2#

#

J/+A7

2164

215#

353

3#2

1213

42

23

2#

1638

14#8

5618

1"8

11#8

#"8

$ROSNTAS

#

IS MASYARAKAT (STBM) ………… TAHUN 2017

Sumber Air Bersih

Sumur +ain0 B.r -ali lain

S$A+ Sarana $en'el.laan $en'el.laan T*k Ke*ap &T$S Air /inum Sampah Ke*ap Air Air

IS MASYARAKAT (STBM)

Sumber Air Bersih

Sumur +ain0 B.r -ali lain

43

#

#

S$A+ Sarana $en'el.laan $en'el.laan T*k Ke*ap &T$S Air /inum Sampah Ke*ap Air Air

4#

54

3

13

41

43

#

#

42

51

#

12

3"

33

#

#

33

42

#

14

2!

11"

#

#

115

14

3

3"

1#!

6!

#

#

45

6

#

12

64

3

#

#

33

5

5

12

6

61

#

#

33

61

6#

15

46

5"

#

#

4

55

6

!

56

64

#

#

62

64

64

35

2"

325

#

#

1

331

25

!2

262

!4

#

#

!4

!5

!4

#

!5

5

#

#

5

5

5

#

5

15"

#

#

15"

16#

15"

#

16#

""

#

#

"5

""

#

33

66

11#

#

#

1##

11#

#

25

!5

6!

#

#

66

6!

#

11

5

65

#

#

6#

65

#

12

53

4

#

#

2

4

#

23

51

416

#

#

3"3

416

#

1#4

312

IS MASYARAKAT (STBM)

Sumber Air Bersih

Sumur +ain0 B.r -ali lain

S$A+ Sarana $en'el.laan $en'el.laan T*k Ke*ap &T$S Air /inum Sampah Ke*ap Air Air

!3

#

#

3

!3

#

13

#

6

#

#

#

4

#

2"

45

6

#

#

#

"1

#

1"

2

64

#

#

62

66

#

2

64

5"

#

#

61

62

#

6

56

34#

#

#

1"6

36

#

6"

3#

56

#

#

5!"

"2

#

13

61"

6!

#

#

6!

6!

#

5

63

6#

#

#

6#

6!

#

1

51

2

#

#

2

2

#

22

5#

2##

#

#

2##

2#!

#

44

164

3!

#

#

3!

43

3!

#

43

25

#

#

25

25

25

#

25

5#

#

#

5#

633

5#

2

61

4"

#

#

4"

5!

4"

#

5!

162

#

#

162

5"

162

2

1!

41

#

#

41

52

#

1

52

51

#

#

4!

51

#

3

4!

4

#

#

41

52

#

5

4

13"

#

#

13#

155

#

"

14

113

#

#

125

16"

#

#

155

1"3

#

#

165

221

5""

34"

1!#2

IS MASYARAKAT (STBM)

Sumber Air Bersih

Sumur +ain0 B.r -ali lain

S$A+ Sarana $en'el.laan $en'el.laan T*k Ke*ap &T$S Air /inum Sampah Ke*ap Air Air

113

#

#

125

16"

#

#

155

11"

#

#

115

14

3

3"

1#!

325

#

#

1

344

25

!2

262

15"

#

#

15"

16#

15"

#

16#

56

#

#

5!"

"2

#

13

61"

2##

#

#

2##

2#!

#

44

164

162

#

#

162

1!"

162

2

1!

13"

#

#

13#

155

#

"

14

1"3

#

#

165

2164

5""

34"

1!#2

"128 ##8 ##8 668

1###8

28 1628 !3!8

N.

NKATOR nama pemilik rumah Jml KK Jml Ji%a

a

A Kepemilikan Jamban 1 2 3

&emplun' seha( &emplun' )*ak seha( +eher an'sa *' sep), (ank

4 +eher an'sa (anpa sep), (ank

b

5

Numpan'

6

BAB Sembaran'an

B Sumber Air Bersih 1 Sumur -ali 2 B.r 3 +ain0lain

, *

& SARANA &T$S  $en'el.laan Air /inum

e

 $en'el.laan Sampah



9 S$A+ 1 Ke*ap Air 2 T*k Ke*ap Air

9NS O$RASONA+ $N-RTAN Nama $emilik rumah ;an' *iperiksa Jumlah KK ;an' a*a *alam sa(u rumah ;an' *iperiksa Jml men''unakan *.kerbis be(.n? Jamban ,emplun'  blun' ;an' )*ak a*a penu(up pa*a luban' %alaupun *iberi (ambahan p.mpa air? Su*ah Jelas Apabila men''unakan sarana air bersih ;an' lain : sun'ai= sumur p.mpa (an'an= $A/ Keluar'a memiliki sarana ,u,i (an'an pakai sabun seper) : kran airpa*asan ;an' (erse*ia airn;a= sabun An''.(a keluar'a ;an' *iperiksa men'el.la air men(ah >merebus air= men''unakan Air isi lan'= air Kemasan? un(uk keperluan memasak *an minum An''.(a keluar'a memisahkan an(ara sampah .r'anik *an an .r'anik ser(a )*ak membuan' sampah sembaran'an Saluran $embuan'an Air +imbah Apabila saluran pembuan'an air limbah *iples(er *an )*ak *iresapkan ke *alam (anah Apabila saluran pembuan'an air limbah masih berupa (anah ;an' *iresapkan *i pekaran'an

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS DESA JATI TAHUN 2016

Kepemilikan Jamban

NO

RT  RW

1 KA@N

+eher +eher Jml Jml an'sa Jml KK Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

BAB Numpan' Sembaran 'an

136

1#

"2

34

#

#

#

2 KRRJO

45

#

!

35

#

#

2

3 KARAN-

325

3#

#

2#5

#

#

#

4 JAT

324

54

4"

221

#

#

#

5 BANTN-AN 6 BB-AN

322

!1 15

2 #

23 !4

2 1

# #

# #

53

#

3#

#

#

#

3"

#

13

#

#

#

 BAN@R$ ! K+ANN-

16

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS DESA JATI TAHUN 2017

Kepemilikan Jamban

NO

K7

1 KA@N

+eher +eher Jml Jml an'sa Jml KK Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank 114

#

BAB Numpan' Sembaran 'an

1##

#

6!

3

#

"

#

2 KRRJO

5#

5#

4

#

46

#

#

#

3 KARAN-

224

1!"

5

5!

12#

1

4

#

4 JAT

3"2

32

!4

2

2#"

#

3

#

5 BANTN-AN

2"

26!

3

5

1"2

#

2

#

6 BB-AN

112

1#6

#

11

!

#

1"

#

"4

!2

23

21

42

#

!

1

! K+ANN-

1!1

145

2"

#

""

#

53

#

J/+A7

1464

126

14!

26#

!23

1

236

1

31

2!

#

24



#

#

#

 BAN@R$

KA@ RT16

3!4

RT 26

2#

1

#

14

5

#

1

#

RT 36

31

2!

#

24

6

#

1

#

RT 46

32

2

#

6

1"

#



#

1##

#

6!

3

#

"

#

114

#

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS DESA JATI TAHUN 2017

Kepemilikan Jamban

NO

K7

1 KA@N

+eher +eher Jml Jml an'sa Jml KK Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank 114

#

BAB Numpan' Sembaran 'an

1##

#

6!

3

#

"

#

2 KRRJO

5#

5#

4

#

46

#

#

#

3 KARAN-

224

1!"

5

5!

121

#

4

#

4 JAT

3"2

32

!4

2

2#"

#

3

#

5 BANTN-AN

2"

26!

3

5

1"2

#

2

#

6 BB-AN

112

1#6

#

11

!

#

1"

#

"4

!2

23

21

42

#

!

#

! K+ANN-

1!1

145

2"

#

""

#

53

#

J/+A7

1464

126

14!

26#

!24

#

236

#

1#18

1!8

5638

##8

1618

##8

 BAN@R$

$ROSNTAS

3!4

ASYARAKAT (STBM)

Sumber Air Bersih

Sumur B.r -ali

S$A+

$en'el.la $en'el.la Sarana an Air an +ain0 &T$S Ke*ap /inum Sampah lain Air

T*k Ke*ap Air

136

#

#

136

136

#

#

136

44

#

#

44

45

#

#

45

235

#

#

235

235

#

#

235

324

#

#

324

324

#

#

324

2! "!

44 #

# #

# #

322 "!

# "!

# #

322 "!

!3

#

#

!3

!3

#

#

!3

16"

1#

#

16

16

1#

3

13

ASYARAKAT (STBM)

Sumber Air Bersih

Sumur B.r -ali

S$A+

$en'el.la $en'el.la Sarana an Air an +ain0 &T$S Ke*ap /inum Sampah lain Air

T*k Ke*ap Air

1##

#

#

3

111

#

#

1##

5#

#

#

5#

5#

5#

#

5#

13

#

4

5

224

#

3

1!6

2!6



#

22

3"2

3#5

3

324

234

1"

#

25"

2"

2#!

#

26!

1#6

#

#

"

1#"

1#4

#

1#6

!2

#

#

5

"4

#

#

!2

142

3

#

144

16

145

1

144

113

2"

4

!!

1453

!12



126#

2!

#

#

#

31

#

#

2!

$NATAAN AS+

1

#

#

1

1

#

#

1

2!

#

#

#

31

#

#

2!

2

#

#

2

32

#

#

2

1##

#

#

3

111

#

#

1##

ASYARAKAT (STBM)

Sumber Air Bersih

Sumur B.r -ali

S$A+

$en'el.la $en'el.la Sarana an Air an +ain0 &T$S Ke*ap /inum Sampah lain Air

T*k Ke*ap Air

1##

#

#

3

111

#

#

1##

5#

#

#

5#

5#

5#

#

5#

13

#

4

5

224

#

3

1!6

2!6



#

22

3"2

3#5

3

324

234

1"

#

25"

2"

2#!

#

26!

1#6

#

#

"

1#"

1#4

#

1#6

!2

#

#

5

"4

#

#

!2

142

3

#

144

16

145

1

144

113

2"

4

!!

1453

!12



126#

#38 6#68

""28

5558

#68

""48

!#18 2#8

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS MA DESA DOPLANG TAHUN 2017

Kepemilikan Jamban

NO

K7

+eher Jml Jml KK Jml Ji%a Rumah &emplun' &emplun' an'sa *' Seha( )*ak Seha( sep), (ank

+eher an'sa (anpa sep), (ank

BAB Numpan' Sembaran 'an

1 O$+AN-

4#5

36

1#

6

32!

1

43

1

2 K7AN

524

443





3"4

#

24

#

3 K+ATAK

62!

55#

6

11

4##

22

11!

1

4 N-AS/

153

134

"6

#

4

#

1#

#

5 -+ON--ON-

144

144

25

42

#

#



#

6 -RO-O+

163

14#

61

16

5"

2

25

#

 TR/BS

1!#

155

1#

3!

66

#

4#

2#

5#

5#

5

1"

1

#

#

"

1""2

2"#

13"

13!1

41

26

31

12"8

628

6158

1!8

11"8

148

! B+-ANJ/+A7

224

#

#

$ROSNTAS

N-AS/ 41 

41

3!

2#

#

1!

#

3

#

42  43 

6" 43

5" 3

3" 3

# #

25 4

# #

5 2

# #

134

"6

#

4

#

1#

#

153

#

YARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

S$A+

$en'el.l $en'el.l Sarana T*k aan +ain0 &T$S aan Air Ke*ap Ke*ap /inum Sampah Air lain Air

B.r

31!

55

1

114

4#5

#

#

36

414

2

#

22

524

#

"6

34

41

#

24

244

62!

1

1#5

445

"

#

#

1

153

#

4

13#

116

#

#

5"

144

#

21

123

124

#

#

1

163

#

#

14#

13!

#

#

13#

1!#

#

#

155

46

#

#

3

5#

#

#

5#

1#6

5

25

!24

224

1

226

166

5"8 258 118

368

1###8

##48 1138 !!8

22

#

#

#

41

#

#

3!

3" 1!

# #

# #

1 #

6" 43

# #

4 #

55 3

"

#

#

1

153

#

4

13#

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS DESA JEGONG TAHUN 2017

Kepemilikan Jamban

NO

K7

Jml Jml Jml KK Ji%a Rumah &emplun' &emplun' Seha( )*ak Seha(

+eher an'sa *' sep), (ank

+eher an'sa (anpa sep), (ank

BAB Numpan' Sembaran 'an

1 B/RJO

13"

13!

3

#

63

#

3

#

2 J-ON-

21!

1"5

21

5#

113

#

34

#

3 K/AO7

1!"

166

2

!1

56

1

2"

1"

4 BS

22"

1"1

"

23

!4



24

#

6"#

15

154

316

!

"#

1"

J/+A7

5

#

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS DESA JEGONG TAHUN 2017

Kepemilikan Jamban

NO

K7

Jml Jml Jml KK Ji%a Rumah &emplun' &emplun' Seha( )*ak Seha(

+eher an'sa *' sep), (ank

+eher an'sa (anpa sep), (ank

BAB Numpan' Sembaran 'an

1 B/RJO

13"

13!

42

31

63

#

3

#

2 J-ON-

21!

1"5

21

5#

113

#

34

#

3 K/AO7

1!"

166

2

!1

56

1

2"

1"

4 BS

22"

1"1

"

23

!4



24

#

6"#

144

1!5

316

!

"#

1"

1!68

23"8

4#!8

1#8

1168

258

J/+A7 $ROSNTAS

5

#

ASYARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

S$A+

Sarana +ain0 &T$S lain

B.r

$en'el.la $en'el.la T*k an Air an Ke*ap Ke*ap /inum Sampah Air Air

13!

#

#

41

13"

#

#

13!

1"4

#

#

1#!

21!

#

26

16"

164

#

#

31

1!"

#

#

166

1"#

#

#

134

22"

#

2!

163

6!6

#

#

314

5

#

54

636

ASYARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

S$A+

Sarana +ain0 &T$S lain

B.r

$en'el.la $en'el.la T*k an Air an Ke*ap Ke*ap /inum Sampah Air Air

13!

#

#

41

13"

#

#

13!

1"4

#

#

1#!

21!

#

26

16"

164

#

#

31

1!"

#

#

166

1"#

#

#

134

22"

#

2!

163

6!6

#

#

314

5

#

54

636

!!58 ##8 ##8

45!8

1###8

##8

!8 "228

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS DESA PENGKOL JAGONG TAHUN 2017

Kepemilikan Jamban

NO

K7

1 $N-KO+ 2 T/RN-

Jml KK

+eher Jml Jml Ji%a Rumah &emplun' &emplun' an'sa *' Seha( )*ak Seha( sep), (ank

+eher an'sa (anpa sep), (ank

BAB Numpan' Sembara n'an

4

#

#

11

5

#

5

1

236

21"

1"

4

13!

14

16

#

3 B+KAN

51

151

41

#

21

14

#

12

4

4 RJOSAR

5

11

51

33

6

15

#

3

#

5 K+W7

5

24

4

25



23

2

1

1!

6 B+RJO

33

1#3

2!

1#

#

23

#

#

#

 JA-ON-

15"

5#6

15"

2

56

"!

#

3

#

! A+AS /A+AN-

1#4

1#4

4!

#

2

1

2

26

" BANARAN

126

""

1#

16

6"

#

2"

2

J/+A7

"15

!45

14

164

464

1

1

51

46

46

2

#

1#

1

2

6

5!

21

#

1

#

#

2#

1#4

4!

#

2

1

2

26

A+AS /A+AN-

5!

3

2#1

1#4

BANARAN

51

15!

3"



1#

24

#

1#

#

54

155

41

2

4

2"

#

1

2

21

64

1"

1

2

16

#

2

#

126

3

""

1#

16

6"

#

2"

2

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS DESA PENGKOL JAGONG TAHUN 2017

Kepemilikan Jamban

NO

K7

1 $N-KO+

Jml KK

4

+eher Jml Jml &emplun' &emplun' an'sa *' Ji%a Rumah Seha( )*ak Seha( sep), (ank

#

#

11

5

+eher an'sa (anpa sep), (ank

BAB Numpan' Sembara n'an

#

5

1

2 T/RN-

236

21"

1"

4

13!

14

16

#

3 B+KAN

51

151

41

#

21

14

#

12

4

4 RJOSAR

5

11

51

22

6

15

#

3

11

5 K+W7

5

24

4

25



23

2

1

1!

6 B+RJO

33

1#3

2!

!

#

23

#

#

2

 JA-ON-

15"

5#6

15"

2

56

"!

#

3

#

! A+AS /A+AN-

1#4

1#4

#

4!

2

1

2

26

" BANARAN

126

""

1#

16

6"

#

2"

2

J/+A7

"15

!45

!6

212

464

1

1

64

"48

2328

5#8

1"8

!8

#8

$ROSNTAS

3

ASYARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

S$A+

Sarana +ain0 &T$S lain

B.r

$en'el.la $en'el.l T*k an Air aan Ke*ap Ke*ap /inum Sampah Air Air

24

1

3

1

4

#

#

#

214

#

#

#

236

14

5

214

3

#

#

2"

51

#

#

41

5

#

#

#

5

#

#

5

4

2"

#

#

5

#

#

4

33

#

#

#

33

#

#

33

15"

#

#

15

15"

#

#

15"

!2

3

#

#

1#4

#

#

1#4

56

36

#

#

126

#

1

111

#"

6"

3

45

"15

14

6

!63

46

#

#

#

46

#

#

46

36

3

#

#

5!

#

#

5!

!2

3

#

#

1#4

#

#

1#4

1

15

#

#

51

#

#

3"

2#

21

#

#

54

#

1

53

1"

#

#

#

21

#

#

1"

56

36

#

#

126

#

1

111

ASYARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

24

S$A+

Sarana +ain0 &T$S lain

B.r

1

3

1

$en'el.la $en'el.l T*k an Air aan Ke*ap Ke*ap /inum Sampah Air Air

4

#

#

#

AS+

214

#

#

#

236

14

5

214

3

#

#

2"

51

#

#

41

5

#

#

#

5

#

#

51

4

2"

#

#

5

#

#

4

33

#

#

#

33

#

#

2!

15"

#

#

15

15"

#

#

15"

!2

3

#

#

1#4

#

#

1#4

56

36

#

#

126

#

1

"!

#"

6"

3

45

"15

14

6

!3"

58 58 #38

4"8

1###8

158

#8

""38

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS M DESA BANGKLEYAN TAHUN 2017

Kepemilikan Jamban

NO

K7

Jml KK

+eher +eher Jml an'sa Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

Jml Ji%a

1 BAN-K+@AN

116

2 $+OSORJO

1#"

15

6"

26

#

4

#

16!

14

1

143

1!

#

6

#

3 /N

144

131

16

!#

23

4

!

13

4 KRN-N

136

11!

3"

61

32

#

4

#

5 B-AN

136

11

13

54

52

3

14

#

6 $NTK

141

112

13

4!

4!

1

2!

2

 BNO

126

115

""

#

15

#

12

#

! -ROWON-

#

BAB Numpan' Sembara n'an

#

" +OK

1!1

#

16#

3

134

2"

#

14

#

1# SN-ON

16

#

15

12"

2

16

#

2"

#

11 SA/BRJO

113

!3

#

55

3"

2

16

#

12 $&N-

"#

#

!4

32

1

1#

#

15

#

J/+A7

152

#

1333

36#

64

3#!

1#

15#

15

66

61

15

26

1"

#

4

#

5#

4!

#

43



#

#

#

1#"

15

6"

26

#

4

#

32

32

#

#

#

#

#

#

5!

52

32

1

1#

#

15

#

!4

32

1

1#

#

15

#

62

54

53

#

4

#

5

#

65

6#

4#

2

"

#

14

#

4"

43

36

#

3

#

1#

#

BAN-K+@AN

116 $&N-

"# SN-ON

#

#

16

+OK

15

12"

2

16

#

2"

#

65

6#

1

42

1

#

5

#

63

56

2

46

"

#

5

#

53

44

#

46

3

#

4

#

16#

3

134

2"

#

14

#

1!1

#

#

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS M DESA BANGKLEYAN TAHUN 2017

Kepemilikan Jamban

NO

K7

Jml KK

1 BAN-K+@AN

116

2 $+OSORJO

Jml Ji%a

#

+eher +eher Jml an'sa Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

BAB Numpan' Sembara n'an

1#"

15

64

26

#

4

5

16!

14

1

141

1!

#

6

2

3 /N

144

131

16

!#

23

4

!

13

4 KRN-N

136

11!

3"

61

32

#

4

#

5 B-AN

136

11

13

54

52

3

14

#

6 $NTK

141

112

13

4!

4!

1

2!

2

 BNO

126

115

!#

15

15

#

12

4

! -ROWON-

12"

11

6

3"

2

#

12

#

" +OK

1!1

#

16#

3

134

2"

#

14

#

1# SN-ON

16

#

15

46

!2

16

#

2"

3

11 SA/BRJO

113

!3

#

55

3"

2

16

#

12 $&N-

"#

#

!4

32

1

1#

#

15

32

J/+A7

1656

#

145#

264

4

3!#

1#

162

61

15"8

468

22"8

#68

"!8

38

$ROSNTAS

SYARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

S$A+

$en'el.la $en'el.l Sarana T*k an Air aan +ain0 &T$S Ke*ap B.r Ke*ap /inum Sampah lain Air Air

3

1

#

1

116

#

#

1#"

11#

3

#

#

16!

#

#

14

12!

3

#

4!

144

#

#

131

"

2

#

#

136

#

#

11!

12#

#

#

#

136

#

#

11

"!

4

#

#

141

#

1

111

63

#

#

#

126

#

#

115 AS+

!!

1

#

"3

1!1

#

6

154

56

#

21

3#

16

#

23

134

!3

#

#

#

113

#

#

!3

5

#

#

1

"#

#

#

!4

"55

14

21

13

152

#

3#

13#3

22

1

#

1

66

#

#

61

15

#

#

#

5#

#

#

4!

3

1

#

1

116

#

#

1#"

32

#

#

#

32

#

#

32

43

#

#

1

5!

#

#

52

5

#

#

1

"#

#

#

!4

22

#

#

11

62

#

#

54

22

#

21

13

65

#

22

3!

12

#

#

6

4"

#

1

42

56

#

21

3#

16

#

23

134

3

#

#

3

65

#

4

56

2"

1

#

4#

63

#

2

54

22

#

#

16

53

#

#

44

!!

1

#

"3

1!1

#

6

154

SYARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

S$A+

$en'el.la $en'el.l Sarana T*k an Air aan +ain0 &T$S Ke*ap B.r Ke*ap /inum Sampah lain Air Air

3

1

#

1

116

#

#

1#"

11#

3

#

#

16!

#

#

14

12!

3

#

4!

144

#

#

131

"

2

#

#

136

#

#

11!

12#

#

#

#

136

#

#

11

"!

4

#

#

141

#

1

111

63

#

#

#

126

#

#

115

1#5



#

5"

12"

#

26

"1

!!

1

#

"3

1!1

#

6

154

56

#

21

3#

16

#

23

134

!3

#

#

#

113

#

#

!3

5

#

#

1

"#

#

#

!4

1#6#

21

21

232

1656

#

56

13"4

64#8 138 138 14#8

1###8

##8

3"8

"618

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS MA DESA JATI TAHUN 2017

Kepemilikan Jamban

NO

K7

Jml KK

+eher +eher Jml Jml an'sa Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

BAB Numpan' Sembara n'an

1 SN--T

2!

244

24

64

"6

4

43

13

2 T+O-O

21#

1!#

#

1#"

#

1

2!

2

3 N-+N--O

121

116

"1

#

15

#

13

2

4 STRN

16

13!

2

4

5"

3

32

4

5 KA@N 6 S/BRAN

14" !2

14" "

# 4

1#5 32

41 26

# #

3 6

1 13

 SA/BROTO

215

1!2

! KRTN-A7

11"

"!

31

#

6

#

#

#

135"

11!6

152

3!4

44"

!

143

35

J/+A7

5

1!

FORMULIR PENDATAAN CAKUPAN SANITASI TOTAL BERBASIS MA DESA SINGGET TAHUN 2017

Kepemilikan Jamban

NO

K7

Jml KK

+eher +eher Jml Jml an'sa Ji%a Rumah &emplun' &emplun' an'sa *' (anpa Seha( )*ak Seha( sep), sep), (ank (ank

BAB Numpan' Sembara n'an

1 SN--T

2!

244

6

64

"6

4

43

13

2 T+O-O

24#

2#2

15

1#"

#

1

3!



3 N-+N--O

164

143

"1

2"

15

#

2

2

4 STRN

1!5

13!

2

65

5"

3

52

4

5 KA@N

2#1

1!

3

1#5

41

#

14

4

6 S/BRAN

115

"4

13

26

42

#

21

13

 SA/BROTO

215

1!2

3!

64

5

3

33

2

! KRTN-A7

11"

"!

31

#

6

#

21

#

J/+A7 $ROSNTAS

1526

12!!

2"4

462

465

11

24"

45

1"28

3#2!8

361#8

#28

16328

2"58

SYARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

S$A+

Sarana +ain0 &T$S lain

B.r

$en'el.la $en'el.l T*k an Air aan Ke*ap Ke*ap /inum Sampah Air Air

216

4!

#

6

2!

52

41

2#3

1!#

#

#

1#6

21#

3

5

15

116

#

#

"

121

#

#

143

"5

#

#

#

16

#

35

1#3

66 5"

# #

# #

# 34

14" 6

# #

1" #

13# !2

"!

#

#

2

"!

#

#

"!

!3#

4!

#

2"

111

55

1##

"34

SYARAKAT (STBM)

Sumber Air Bersih

Sumur -ali

S$A+

Sarana +ain0 &T$S lain

B.r

$en'el.la $en'el.l T*k an Air aan Ke*ap Ke*ap /inum Sampah Air Air

216

4!

#

6

2!

52

41

2#3

1!#

#

#

1#6

21#

3

5

1"

116

#

#

"

121

#

#

143

13!

#

#

#

16

#

35

1#3

16

#

#

#

14"

#

1"

16!

""

#

#

34

6

#

#

"4

15

6

#

26

215

6

4

1!

"!

#

#

2

"!

#

#

"!