bupati tulungagung provinsi jawa timur

B U P A T I T U L U N G A G U N G P R O V I N S I J A W A T I M U R

P E R A T U R A N B U P A T I T U L U N G A G U N G N O M O R 8 0 T A H U N 2 0 2 0

T E N T A N G P E R U B A H A N A T A S P E R A T U R A N B U P A T I N O M O R 7 2 T A H U N 2 0 1 6

T E N T A N G P E D O M A N T A T A N A S K A H D I N A S D I L I N G K U P P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G

D E N G A N R A H M A T T U H A N Y A N G M A H A E S A

B U P A T I T U L U N G A G U N G ,

M e n i m b a n g : b a h w a d e n g a n a d a n y a p e r u b a h a n n o m e n k l a t u r P e r a n g k a t D a e r a h d i L i n g k u p P e m e r i n t a h K a b u p a t e n T u l u n g a g u n g b e r d a s a r k a n P e r a t u r a n D a e r a h K a b u p a t e n T u l u n g a g u n g N o m o r 1 0 T a h u n 2 0 1 9 t e n t a n g P e r u b a h a n K e d u a A t a s P e r a t u r a n D a e r a h N o m o r 2 0 T a h u n 2 0 1 6 T e n t a n g P e m b e n t u k a n d a n S u s u n a n P e r a n g k a t D a e r a h K a b u p a t e n T u l u n g a g u n g , p e r l u d i l a k u k a n p e r u b a h a n a t a s P e r a t u r a n B u p a t i N o m o r 7 2 T a h u n 2 0 1 6 t e n t a n g P e d o m a n T a t a N a s k a h D i n a s d i L i n g k u p P e m e r i n t a h K a b u p a t e n T u l u n g a g u n g y a n g d i t e t a p k a n d e n g a n P e r a t u r a n B u p a t i ;

M e n g i n g a t : 1 . U n d a n g - U n d a n g N o m o r 2 4 T a h u n 2 0 0 9 t e n t a n g B e n d e r a , B a h a s a d a n L a m b a n g N e g a r a s e r t a L a g u K e b a n g s a a n ( L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 0 9 N o m o r 1 0 9 , T a m b a h a n L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a N o m o r 5 0 3 5 ) ;

2 . U n d a n g - U n d a n g N o m o r 1 2 T a h u n 2 0 1 1 t e n t a n g P e m b e n t u k a n P e r a t u r a n P e r u n d a n g - u n d a n g a n ( L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 1 1 N o m o r 8 2 , T a m b a h a n L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a N o m o r 5 2 3 4 ) , s e b a g a i m a n a t e l a h d i u b a h d e n g a n U n d a n g - U n d a n g N o m o r 1 5 T a h u n 2 0 1 9 L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 1 9 N o m o r 1 8 3 , T a m b a h a n L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a N o m o r 6 3 9 8 ) ;

3 . U n d a n g - U n d a n g N o m o r 2 3 T a h u n 2 0 1 4 t e n t a n g P e m e r i n t a h a n D a e r a h ( L e m b a r a n N e g a r a T a h u n 2 0 1 4 N o m o r 2 4 4 , T a m b a h a n L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a N o m o r 5 5 8 7 ) , s e b a g a i m a n a t e l a h d i u b a h b e b e r a p a k a l i , t e r a k h i r d e n g a n U n d a n g - U n d a n g N o m o r 9 T a h u n 2 0 1 5 ( L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 1 5 N o m o r 5 8 , T a m b a h a n L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a N o m o r 5 6 7 9 ) ;

- 2 -

4 . U n d a n g - U n d a n g N o m o r 3 0 T a h u n 2 0 1 4 t e n t a n g A d m i n i s t r a s i P e m e r i n t a h a n ( L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 1 4 N o m o r 2 9 2 , T a m b a h a n L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a N o m o r 5 6 0 1 ) ;

5 . P e r a t u r a n P e m e r i n t a h N o m o r 1 8 T a h u n 2 0 1 6 t e n t a n g P e r a n g k a t D a e r a h ( L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 1 6 N o m o r 1 1 4 , T a m b a h a n L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a N o m o r 5 8 8 7 ) , s e b a g a i m a n a t e l a h d i u b a h d e n g a n P e r a t u r a n P e m e r i n t a h N o m o r 7 2 T a h u n 2 0 1 9 ( L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 1 9 N o m o r 1 8 7 , T a m b a h a n L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a N o m o r 6 4 0 2 ) ;

6 . P e r a t u r a n M e n t e r i D a l a m N e g e r i N o m o r 5 4 T a h u n 2 0 0 9 t e n t a n g T a t a N a s k a h d i L i n g k u n g a n P e m e r i n t a h D a e r a h ;

7 . P e r a t u r a n M e n t e r i D a l a m N e g e r i N o m o r 5 6 T a h u n 2 0 1 5 t e n t a n g K o d e d a n D a t a W i l a y a h A d m i n i s t r a s i P e m e r i n t a h a n ( B e r i t a N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 1 5 N o m o r 1 0 4 5 ) ;

8 . P e r a t u r a n D a e r a h K a b u p a t e n T u l u n g a g u n g N o m o r 2 0 T a h u n 2 0 1 6 t e n t a n g P e m b e n t u k a n d a n S u s u n a n P e r a n g k a t D a e r a h K a b u p a t e n T u l u n g a g u n g ( L e m b a r a n D a e r a h K a b u p a t e n T u l u n g a g u n g T a h u n 2 0 1 6 N o m o r 1 S e r i D ) , s e b a g a i m a n a t e l a h d i u b a h b e b e r a p a k a l i , t e r a k h i r d e n g a n P e r a t u r a n D a e r a h K a b u p a t e n T u l u n g a g u n g N o m o r 1 0 T a h u n 2 0 1 9 L e m b a r a n D a e r a h K a b u p a t e n T u l u n g a g u n g T a h u n 2 0 1 6 N o m o r 2 S e r i D ) ;

9 . P e r a t u r a n D a e r a h K a b u p a t e n T u l u n g a g u n g N o m o r 2 T a h u n 2 0 1 9 t e n t a n g P e m b e n t u k a n P r o d u k H u k u m D a e r a h ( L e m b a r a n D a e r a h K a b u p a t e n T u l u n g a g u n g T a h u n 2 0 1 9 N o m o r 1 S e r i E ) ;

1 0 . P e r a t u r a n B u p a t i T u l u n g a g u n g N o m o r 7 2 T a h u n 2 0 1 6 P e d o m a n T a t a N a s k a h D i n a s d i L i n g k u p P e m e r i n t a h K a b u p a t e n T u l u n g a g u n g ( B e r i t a D a e r a h K a b u p a t e n T u l u n g a g u n g T a h u n 2 0 1 6 N o m o r 7 2 ) ;

M E M U T U S K A N :

M e n e t a p k a n : P E R A T U R A N B U P A T I T E N T A N G P E R U B A H A N A T A S P E R A T U R A N B U P A T I N O M O R 7 2 T A H U N 2 0 1 6 T E N T A N G P E D O M A N T A T A N A S K A H D I N A S D I L I N G K U P P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G .

K e t e n t u a n L a m p i r a n I I , L a m p i r a n I I I , L a m p i r a n I V d a n L a m p i r a n V d a l a m P e r a t u r a n B u p a t i T u l u n g a g u n g N o m o r 7 2 T a h u n 2 0 1 6 t e n t a n g P e d o m a n T a t a N a s k a h D i n a s d i L i n g k u p P e m e r i n t a h K a b u p a t e n T u l u n g a g u n g ( B e r i t a D a e r a h K a b u p a t e n T u l u n g a g u n g T a h u n 2 0 1 6 N o m o r 7 2 ) d i u b a h , s e h i n g g a b e r b u n y i s e b a g a i m a n a t e r c a n t u m d a l a m L a m p i r a n L a m p i r a n I I , L a m p i r a n I I I , L a m p i r a n I V d a n L a m p i r a n V d a l a m P e r a t u r a n B u p a t i i n i .

P a s a l I

- 3 -

P a s a l I I

P e r a t u r a n B u p a t i i n i m u l a i b e r l a k u p a d a t a n g g a l d i u n d a n g k a n .

A g a r s e t i a p o r a n g m e n g e t a h u i n y a , m e m e r i n t a h k a n p e n g u n d a n g a n P e r a t u r a n B u p a t i i n i d e n g a n p e n e m p a t a n n y a d a l a m B e r i t a D a e r a h K a b u p a t e n T u l u n g a g u n g .

D i t e t a p k a n d i T u l u n g a g u n g p a d a t a n g g a l 3 0 N o p e m b e r 2 0 2 0 B U P A T I T U L U N G A G U N G ,

M A R Y O T O B I R O W O

u n g a g u n g 2 0 2 0

D i u n d a n g k a n d i T u p a d a t a n g g a l 3 0 N o v e m b e r

^ S E K R E T A R I S D A E R R H

D r s . S U K A J L M . S i . P e m b i n a U t a m a M u d a N I P . 1 9 6 4 0 1 1 9 1 9 8 5 0 8 1 0 0 3

B e r i t a D a e r a h K a b u p a t e n T u l u n g a g u n g T a h u n 2 0 2 0 N o m o r 8 0

L A M P I R A N I I P E R A T U R A N B U P A T I T U L U N G A G U N G N O M O R : 8 0 T A H U N 2 0 2 0 T A N G G A L : 3 0 N O P E M B E R 2 0 2 0

B E N T U K , U K U R A N , I S I S E R T A A K R O N I M P A D A S T E M P E L P E R A N G K A T D A E R A H , U K U R A N F O R M N A S K A H D I N A S , P E N G G U N A A N L A M B A N G N E G A R A

D A N L A M B A N G D A E R A H P A D A N A S K A H D I N A S

A . B E N T U K D A N U K U R A N S T E M P E L

1 . Y a n g m e n g g u n a k a n l a m b a n g

C M

2. Y a n g t i d a k m e n g g u n a k a n l a m b a n g

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C . S T E M P E L P E R A N G K A T D A E R A H

1 . C o n t o h S t e m p e l S e k r e t a r i a t D a e r a h

X

X X

X X X

P E M E R I N T A H K A B U P A T E N

T U L U N G A G U N G

S E K R E T A R I A T D A E R A H

2 . C o n t o h S t e m p e l D i n a s D a e r a h

X

X X

X X X

P E M E R I N T A H K A B U P A T E N


D I N A S P E N D I D I K A N , P E M U D A D A N O L A H R A G A

3 . C o n t o h S t e m p e l R S U D

X

X X

X X X

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G

D I N A S K E S E H A T A N

R S U D d r . I S K A K

4 . C o n t o h S t e m p e l B a d a n D a e r a h

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6 . C o n t o h S t e m p e l K e c a m a t a n

X : P E M E R I N T A H K A B U P A T E N

X X

X X X


K E C A M A T A N R E J O T A N G A N

7 . C o n t o h S t e m p e l K e l u r a h a n

X : P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G

X X

X X X

K E C A M A T A N T U L U N G A G U N G

K E L U R A H A N T A M A N A N

8 . C o n t o h S t e m p e l U n i t P e l a k s a n a T e k n i s D i n a s


X X : D I N A S P E N D I D I K A N , P E M U D A D A N O L A H R A G A

X X X : U P T D T A M A N B I N A B A K T I D A N K O M P E T E N S I S I S W A

9 . C o n t o h S t e m p e l U n i t P e l a k s a n a T e k n i s B a d a n


X X

X X X

B A D A N P E N D A P A T A N D A E R A H

U P T P E L A Y A N A N P B B - P 2 D A N B P H T B

D . S T E M P E L P E R A N G K A T D A E R A H U N T U K K E P E R L U A N T E R T E N T U

1,8 C M

i k

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E . A K R O N I M P A D A S T E M P E L P E R A N G K A T D A E R A H

N O N A M A I N S T A N S I A K R O N I M / S I N G K A T A N P I M P I N A N A K R O N I M /

S I N G K A T A N 1 2 3 4 5

1 S e k r e t a r i a t D a e r a h S e t d a S e k r e t a r i s D a e r a h S e k d a

2 S e k r e t a r i a t D e w a n P e r w a k i l a n R a k y a t D a e r a h

S e t w a n S e k r e t a r i s D e w a n S e k w a n

3 I n s p e k t o r a t I n s p e k t o r a t I n s p e k t u r I n s p e k t u r

D i n a s P e n d i d i k a n , P e m u d a d a n O l a h R a g a D i s p e n d i k p o r a K e p a l a D i n a s K a d i s p e n d i k p o r a

5 D i n a s K e s e h a t a n D i n l c p s K e n a l a D i n a s K a r H n k e s

6 D i n a s s o s i a l D i n s o s K e p a l a D i n a s K a d i n s o s

7 D i n a s P e r h u b u n g a n D i s h u b K e p a l a D i n a s K a d i s h u b

8 D m a s K e p e n d u d u k a n d a n P e n c a t a t a n S i p i l D i s p e n d u k c a p i l K e p a l a D i n a s K a d i s p e n d u k c a p i l

9 D i n a s P e r i n d u s t r i a n d a n P e r d a g a n g a n D i s p e r i n d a g K e p a l a D i n a s K a d i s p e r i n d a g

1 0 D m a s P e k e r j a a n U m u m d a n P e n a t a a n R u a n g D i n a s P U P R K e p a l a D i n a s K a d i s P U P R

1 1 D i n a s P e r u m a h a n d a n K a w a s a n P e r m u k i m a n D i s p e r u m K P K e p a l a D i n a s K a d i s p e r u m K P

1 2 D i n a s K o p e r a s i d a n U s a n a M i k r o D i n a s K U M K e p a l a D i n a s K a d i n K U M

1 Q 1 0 D i n a s T e n a g a K e r j a d a n T r a n s m i g r a s i D i s n a k e r t r a n s K e p a l a D i n a s K a d i s n a k e r t r a n s

1 4 D i n a s P e r t a n i a n X—rJLAlA*L\J X Y s X L U J U U 1 1

D i s n e r t a X J A k J A / v A I U

K e n a l a D i n a s K a d i s n e r t a

1 5 D i n a s K o m u n i k a s i d a n I n f o r m a t i k a D i s k o m i n f o K e p a l a D i n a s K a d i s k o m i n f o

1 6 D i n a s P e r i k a n a n D i n a s P e r i k a n a n K e p a l a D i n a s K a d i s P e r i k a n a n

1 7 D i n a s K e t a h a n a n P a n g a n D K P K e p a l a D i n a s K a d i s D K P

1 8 D i n a s K e b u d a y a a n d a n P a r i w i s a t a D i s b u d p a r K e p a l a D i n a s K a d i s b u d p a r

1 9 D i n a s P e m b e r d a y a a n M a s y a r a k a t d a n D e s a D i n a s P M D K e p a l a D i n a s K a d i s P M D

2 0 D i n a s P e t e r n a k a n D i s n a k K e p a l a D i n a s K a d i s n a k

9 1 2 * A

T~J J o a T i n c f k i i f i f f a n T - T i H n n i - / u i y . o i ^ i i i g K u i i g a i A r i i u u p

n T r r t Y C p d J c t U U l i i o

2 2 D i n a s P e r p u s t a k a a n d a n K e a r s i p a n

D i n p e r p u s d a n A r s i p K e p a l a D i n a s K a d i n p e r p u s d a n

A r s i p

2 3 D i n a s P e n a n a m a n M o d a l d a n P e l a y a n a n T e r p a d u S a t u P i n t u

D P M P T S P K e p a l a D i n a s K a D P M P T S P

2 4 S a t u a n P o l i s i P a m o n g P r a j a S a t p o l P P K e p a l a

S a t u a n K a s a t p o l P P

2 5 B a d a n P e n d a p a t a n D a e r a h B a p e n d a

K e p a l a B a d a n K a B a p e n d a

2 6 B a d a n P e r e n c a n a a n P e m b a n g u n a n D a e r a h B a p p e d a K e p a l a

B a d a n K a B a p p e d a

2 7 B a d a n K e p e g a w a i a n d a n P e n g e m b a n g a n S u m b e r D a y a M a n u s i a

B K P S D M K e p a l a B a d a n K a B K P S D M

2 8 B a d a n P e n g e l o l a a n K e u a n g a n d a n A s e t D a e r a h

B P K A D K e p a l a B a d a n

K a B P K A D

- 5 -

2 9 B a d a n K e s a t u a n B a n g s a J r\ 1 * j _ M d a n P o l i t i k

B a k e s b a n g p o l K e p a l a B a d a n

K a K e s b a n g p o l

3 0 R u m a h S a k i t U m u m D a e r a h d r . I s k a k K a b u p a t e n T u l u n g a g u n g

R S U D d r . I s k a k D i r e k t u r D i r e k t u r R S U D

3 1 R u m a h S a l d t U m u m D Q p r o U r * o m m i T Y I O r o 4-U a C I d i i V d J H p U I U d l a L

R S U D v d i i i p i u r i d i d L D i r e k t u r D i r e k t u r R S U D

O 2 , B a d a n P e n a n g g u l a n g a n B e n c a n a D a e r a h

R P R F l D r D L /

K e p a l a B a d a n

Ka R P R F l

3 3 T 7 " _ . —. x_ T l _ J

K e c a m a t a n B a n d u n g K e c . B a n d u n g C a m a t C a m a t

3 4 K e c a m a t a n K a r a n g r e j o K e c . K a r a n g r e j o C a m a t C a m a t

3 5 K e c a m a t a n K a u m a n K e c . K a u m a n C a m a t C a m a t

3 6 K e c a m a t a n N g a n t r u K e c . N g a n t r u C a m a t C a m a t

3 7 K e c a m a t a n K e d u n g w a r u K e c . K e d u n g w a r u C a m a t C a m a t

3 8 K e c a m a t a n T u l u n g a g u n g K e c . T u l u n g a g u n g C a m a t C a m a t

3 9 K e c a m a t a n P a g e r w o j o K e c . P a g e r w o j o C a m a t C a m a t

4 0 K e c a m a t a n G o n d a n g K e c . G o n d a n g C a m a t C a m a t

4 1 K e c a m a t a n P a k e l K e c . P a k e l C a m a t C a m a t

4 2 K e c a m a t a n B e s u k i K e c . B e s u k i C a m a t C a m a t

4 3 K e c a m a t a n C a m p u r d a r a t K e c . C a m p u r d a r a t C a m a t C a m a t

4 4 K e c a m a t a n T a n g g u n g g u n u n g

K e c . T a n g g u n g g u n u n g

C a m a t C a m a t

4 5 K e c a m a t a n P u c a n g l a b a n K e c . P u c a n g l a b a n C a m a t C a m a t

4 6 K e c a m a t a n R e j o t a n g a n K e c . R e j o t a n g a n C a m a t C a m a t

K e c a m a t a n S u m b e r g e m p o l

K e c . S u m b e r g e m p o l C a m a t V d z n d L

I v c L c l l l l c l l c L I l l i g U i l U L \2(±r* M m t r i l i t

I V C L . l i g U U U L V - d l l l d L V d 1 1 1 « L

4 9 K e c a m a t a n B o y o l a n g u K e c . B o y o l a n g u C a m a t C a m a t

5 0 K e c a m a t a n S e n d a n g K e c . S e n d a n g C a m a t C a m a t

5 1 K e c a m a t a n K a l i d a w i r K e c . K a l i d a w i r C a m a t C a m a t

F . U K U R A N F O R M N A S K A H D I N A S

U k u r a n K e r t a s F o l i o / F 4

B e r a t K e r t a s

J a r a k t e p i a t a s k e r t a s

J a r a k t e p i b a w a h k e r t a s

J a r a k t e p i k a n a n k e r t a s

J a r a k t e p i k i r i k e r t a s

B e n t u k f o n t / h u r u f

U k u r a n f o n t / h u r u f

2 1 5 m m x 3 3 0 m m

7 0 g r ( n a s k a h d i n a s b i a s a ) ;

8 0 g r ( n a s k a h p r o d u k h u k u m ) .

2 , 0 c m

2 , 5 c m

2 , 0 c m

3 , 0 c m

Times New Roman ( n a s k a h d i n a s b i a s a ) ;

Bookman Old Syle ( n a s k a h p r o d u k h u k u m ) .

1 2

- 6 -

G . U K U R A N L A M B A N G N E G A R A Y A N G D I P E R G U N A K A N P A D A N A S K A H D I N A S :

25 m m - i

L e b a r L a m b a n g N e g a r a : 2 5 m m

25 m m T i n g g i L a m b a n g N e g a r a : 2 5 m m

F . U K U R A N L A M B A N G D A E R A H Y A N G D I P E R G U N A K A N P A D A N A S K A H D I N A S :

25 m m L e b a r L a m b a n g D a e r a h : 2 0 m m

T i n g g i L a m b a n g D a e r a h : 2 5 m m

L 20 m m -1

B U P A T I T U L U N G A G U N G ,


L A M P I R A N I I I : P E R A T U R A N B U P A T I T U L U N G A G U N G N O M O R : 8 0 T A H U N 2 0 2 0 T A N G G A L : 3 0 N O P E M B E R 2 0 2 0

B E N T U K , U K U R A N , I S I K O P D A N S A M P U L S U R A T

A . B E N T U K D A N U K U R A N K O P S U R A T a . P e r b a n d i n g a n u k u r a n h u r u f p a d a K o p N a s k a h D i n a s a d a l a h 2 : 1 y a i t u :

1 . u k u r a n h u r u f a2" u n t u k t u l i s a n n a m a P e m e r i n t a h D a e r a h 2 . u k u r a n h u r u f " 3 " u n t u k t u l i s a n n a m a i n s t a n s i

b . B e n t u k d a n i s i K o p N a s k a h D i n a s

1 . C o n t o h 1 : K o p N a s k a h D i n a s B u p a t i

B U P A T I T U L U N G A G U N G J a l a n N o . . . T e l p F a k s i m i l e . . . . , w e b s i t e . . . . , K o d e p o s . . . .


2 . C o n t o h 2 : K o p N a s k a h D i n a s S e k r e t a r i a t D a e r a h

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G S E K R E T A R I A T D A E R A H

J i n . A . Y a n i T i m u r N o . 3 7 T e l p . / F a x . ( 0 3 5 5 ) 3 2 1 2 6 0 K o d e P o s 6 6 2 1 7


3 . C o n t o h 3 : K o p N a s k a h D i n a s S e k r e t a r i a t D P R D

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G S E K R E T A R I A T D E W A N P E R W A K I L A N R A K Y A T D A E R A H

J i n T e l p F a x K o d e P o s


4 . C o n t o h 4 : K o p N a s k a h D i n a s D i n a s D a e r a h

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G D I N A S P E N D I D I K A N , P E M U D A D A N O L A H R A G A



- 2 -

5 . C o n t o h 5 : K o p N a s k a h D i n a s D i n a s D a e r a h

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G D I N A S K E S E H A T A N

J i n T e l p F a x . K o d e P o s


6 . C o n t o h 6 : K o p N a s k a h D i n a s B a d a n D a e r a h

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G B A D A N P E N G E L O L A A N K E U A N G A N D A N A S E T D A E R A H



7 . C o n t o h 7 : K o p N a s k a h D i n a s I n s p e k t o r a t

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G I N S P E K T O R A T

J i n . . T e l p F a x K o d e P o s


8 . C o n t o h 8 : K o p N a s k a h D i n a s R U M A H S A K I T U M U M D A E R A H


R U M A H S A K I T U M U M D A E R A H d r I S K A K J i n T e l p . . . . . . . F a x K o d e P o s


9 . C o n t o h 9 : K o p N a s k a h D i n a s U P T D i n a s


U P T L A B O R A T O R I U M K E S E H A T A N D A E R A H J i n T e l p F a x K o d e P o s


1 0 . C o n t o h 1 0 : K o p N a s k a h D i n a s U P T B a d a n

j E g ^ P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G § N y B A D A N P E N D A P A T A N D A E R A H

J U P T B P E L A Y A N A N P B B - P 2 D A N B P H T B J i n T e l p F a x K o d e P o s .


- 3 -

1 1 . C o n t o h 1 1 : K o p N a s k a h D i n a s K e c a m a t a n

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G K E C A M A T A N



1 2 . C o n t o h 1 2 : K o p N a s k a h D i n a s K e l u r a h a n

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G K E C A M A T A N T U L U N G A G U N G

K E L U R A H A N . . . . J i n T e l p F a x K o d e P o s


B . B E N T U K D A N U K U R A N S A M P U L a . B e n t u k S a m p u l

S a m p u l s u r a t b e r b e n t u k e m p a t p e r s e g i p a n j a n g d a n b e r w a r n a c o k l a t m u d a d e n g a n u k u r a n m a s i n g - m a s i n g ;

U K U R A N P A N J A N G L E B A R

K a n t o n g 4 1 c m 3 0 c m F o l i o / M a p 3 5 c m 2 5 c m

% F o l i o 2 8 c m 1 8 c m V* F o l i o 2 8 c m 1 2 c m

b . U k u r a n h u r u f P e r b a n d i n g a n h u r u f 2 : 3 1 . U k u r a n h u r u f " 2 " u n t u k t u l i s a n n a m a P e m e r i n t a h K a b u p a t e n

T u l u n g a g u n g ; 2 . U k u r a n h u r u f " 3 " u n t u k t u l i s a n n a m a i n s t a n s i

c . C o n t o h K o p S a m p u l S u r a t

C o n t o h 1 :

B U P A T I T U L U N G A G U N G J a l a n N o . . . T e l p F a k s i m i l e . . . . , w e b s i t e . . . . , K o d e p o s . . . .

T U L U N G A G U N G K e p a d a

N o m o r : ..../ / / Y t h . S d r . . . .

d i S t e m p e l

K o d e P o s

- 4 -

C o n t o h 2 :

J a l a n . W A K I L B U P A T I T U L U N G A G U N G

N o . . . T e l p F a k s i m i l e . . . . , w e b s i t e . . . . , K o d e p o s . . . . T U L U N G A G U N G j

K e p a d a ./ ! Y t h . S d r .

d i

K o d e P o s

N o m o r : ..../ /,

S t e m p e l

C o n t o h 3 : P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G

S E K R E T A R I A T D A E R A H J i n . A . Y a n i T i m u r N o . 3 7 T e l p . / F a x . ( 0 3 5 5 ) 3 2 1 2 6 0 K o d e P o s 6 6 2 1 7


N o m o r : ..../ / /.

S t e m p e l

K e p a d a Y t h . S d r .

d i

K o d e P o s


I N S P E K T O R A T J i n T e l p F a x K o d e P o s


N o m o r : ..../ / /

S t e m p e l


d i

K o d e P o s

- 5 -

C o n t o h 5 :

J i n .


D I N A S K E S E H A T A N T e l p F a x K o d e P o s



d i

K o d e P o s

N o m o r : ..../ / /.

S t e m p e l


D I N A S K E S E H A T A N R U M A H S A K I T U M U M D A E R A H d r I S K A K



N o m o r : ..../ / /,

S t e m p e l

K e p a d a Y t h . S d r

d i

K o d e P o s


D I N A S K E S E H A T A N U P T L A B O R A T O R I U M K E S E H A T A N D A E R A H



N o m o r : ..../ / /,

S t e m p e l


d i

K o d e P o s

6

- 6 -


K E C A M A T A N J i n T e l p F a x K o d e P o s


N o m o r : ..../ / /.

S t e m p e l

K e p a d a Y t h . S d r

d i

K o d e P o s


K E C A M A T A N T U L U N G A G U N G K E L U R A H A N



N o m o r : ..../. /.

S t e m p e l


d i

K o d e P o s


L A M P I R A N I V : P E R A T U R A N B U P A T I T U L U N G A G U N G N O M O R : 8 0 T A H U N 2 0 2 0 T A N G G A L : 3 0 N O P E M B E R 2 0 2 0

B E N T U K , U K U R A N D A N I S I P A P A N N A M A P E R A N G K A T D A E R A H

B E N T U K D A N B A H A N

B e n t u k P a p a n N a m a P e r a n g k a t D a e r a h d i l i n g k u p P e m e r i n t a h K a b u p a t e n

T u l u n g a g u n g , b e r b e n t u k e m p a t p e r s e g i p a n j a n g d e n g a n b a h a n y a n g t a h a n

t e r h a d a p c u a c a , a m a n b a g i l i n g k u n g a n d a n t i d a k m e m b a h a y a k a n .

U K U R A N

a . U k u r a n H u r u f .

P e r b a n d i n g a n U k u r a n H u r u f 3 : 4 1) U k u r a n h u r u f " 3 " u n t u k t u l i s a n P e m e r i n t a h K a b u p a t e n T u l u n g a g u n g

2 ) U k u r a n h u r u f u4n u n t u k t u l i s a n n a m a P e r a n g k a t D a e r a h

b . L e t a k p a p a n n a m a P e r a n g k a t D a e r a h d i t e m p a t k a n p a d a t e m p a t y a n g

s t r a t e g i s , m u d a h d i l i h a t d a n s e r a s i d e n g a n l e t a k b a n g u n a n n y a .

- 2 -

C o n t o h : 1

K A N T O R B U P A T I T U L U N G A G U N G

J L . N o T e l e p o n .


K o d e P o s

C o n t o h 2 .


S E K R E T A R I A T D A E R A H

J L . . N o T e l e p o n .


K o d e P o s

C o n t o h 3 .


D I N A S P E R I N D U S T R I A N D A N P E R D A G A N G A N

J l . . N o T e l e p o n E m a i l


K o d e P o s

C o n t o h 4 .


B A D A N P E N D A P A T A N D A E R A H

J l N o T e l e p o n E m a i l

T U L U N G A G U N G K o d e P o s

t

- 3 -

C o n t o h 5 .


D I N A S K E S E H A T A N D A E R A H R U M A H S A K I T U M U M D A E R A H d r . I S K A K



C o n t o h 6 .


I N S P E K T O R A T



C o n t o h 7 ,


K E C A M A T A N R E J O T A N G A N J l N o T e l e p o n E m a i l


K o d e P o s

C o n t o h 8 .

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G K E C A M A T A N T U L U N G A G U N G

K E L U R A H A N K E N A Y A N



- 4 -

C o n t o h 9 .


R U M A H S A K I T U M U M D A E R A H d r . I S K A K J l N o T e l e p o n


C o n t o h 1 0 .

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G D I N A S P E N D I D I K A N , P E M U D A D A N O L A H R A G A

U P T T A M A N B I N A B A K A T D A N K O M P E T E N S I S I S W A

J l N o . T e l e p o n


C o n t o h 1 1 .

P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G B A D A N P E N D A P A T A N D A E R A H

U P T P E L A Y A N A N P B B - P 2 D A N B P H T B

J l N o T e l e p o n


C o n t o h 1 2 .

B E N T U K D A N I S I P A P A N N A M A Y A N G T E R L E T A K S A T U A T A P / S A T U K O M P L E K .


J l


1 . 2 . 3 .

B A D A N D I N A S ... D I N A S ...

K o d e P o s

(fi M A R Y O T O B I R O W O

L A M P I R A N V : P E R A T U R A N B U P A T I T U L U N G A G U N G N O M O R : 8 0 T A H U N 2 0 2 0 T A N G G A L : 3 0 N O P E M B E R 2 0 2 0

K O D E W I L A Y A H K E A R S I P A N P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G

N O P E R A N G K A T D A E R A H K O D E

W I L A Y A H K E A R S I P A N

l 2 3

A . P E M E R I N T A H K A B U P A T E N T U L U N G A G U N G 4 0 7 B . S E K R E T A R I A T 0 0 0

1 . S e k r e t a r i a t D a e r a h a . A s i s t e n P e m e r i n t a h a n d a n K e s e j a h t e r a a n R a k y a t

1) B a g i a n T a t a P e m e r i n t a h a n 2 ) B a g i a n K e s e j a h t e r a a n R a k y a t 3 ) B a g i a n H u k u m

0 0 1 0 1 0 0 1 1 0 1 2 0 1 3

b . A s i s t e n P e r e k o n o m i a n d a n P e m b a n g u n a n 1) B a g i a n P e r e k o n o m i a n d a n S u m b e r D a y a A l a m 2 ) B a g i a n A d m i n i s t r a s i P e m b a n g u n a n 3 ) B a g i a n P e n g a d a a n B a r a n g d a n J a s a

0 2 0 0 2 1 0 2 2 0 2 3

c . A s i s t e n A d m i n i s t r a s i U m u m 1) B a g i a n P r o t o k o l d a n K o m u n i k a s i P i m p i n a n 2 ) B a g i a n U m u m 3 ) B a g i a n O r g a n i s a s i

0 3 0 0 3 1 0 3 2 0 3 3

2 . S e k r e t a r i a t D e w a n P e r w a k i l a n R a k y a t D a e r a h 0 4 0

3 . S t a f A h l i B u p a t i a . S t a f A h l i B i d a n g P e m e r i n t a h a n d a n K e s e j a h t e r a a n R a k y a t b . S t a f A h l i B i d a n g E k o n o m i d a n P e m b a n g u n a n

0 5 0 0 5 1 0 5 2

C . D I N A S D A N S A T P O L P P 1 0 0 1 . D i n a s P e k e r j a a n U m u m d a n P e n a t a a n R u a n g

1 . U P T P e n g e l o l a a n J a l a n d a n J e m b a t a n W i l a y a h T u l u n g a g u n g 2 . U P T P e n g e l o l a a n J a l a n d a n J e m b a t a n W i l a y a h N g u n u t 3 . U P T P e n g e l o l a a n J a l a n d a n J e m b a t a n W i l a y a h K a u m a n 4 . U P T P e n g e l o l a a n J a l a n d a n J e m b a t a n W i l a y a h C a m p u r d a r a t 5 . U P T I n s t a l a s i P e n g e l o l a a n L u m p u r T i n j a

1 0 1 1 0 1 . 0 1 1 0 1 . 0 2 1 0 1 . 0 3 1 0 1 . 0 4 1 0 1 . 0 5

2 . D i n a s P e r u m a h a n d a n K a w a s a n P e r m u k i m a n 1 . U P T P e n g e l o l a a n S u m b e r D a y a A i r B a n d u n g 2 . U P T P e n g e l o l a a n S u m b e r D a y a A i r K a u m a n 3 . U P T P e n g e l o l a a n S u m b e r D a y a A i r G o n d a n g 4 . U P T P e n g e l o l a a n S u m b e r D a y a A i r K a r a n g r e j o

1 0 2 1 0 2 . 1 1 0 2 . 2 1 0 2 . 3 1 0 2 . 4

3 . D i n a s K e s e h a t a n 1 . U P T L a b o r a t o r i u m K e s e h a t a n D a e r a h 2 . U P T P u s k e s m a s 3 . R u m a h S a k i t U m u m D a e r a h D r . I s k a k 4 . R u m a h S a k i t U m u m D a e r a h C a m p u r d a r a t

1 0 3 1 0 3 . 0 1 1 0 3 . 0 2 1 0 3 . 0 3 1 0 3 . 0 4

4 . D i n a s P e n d i d i k a n , P e m u d a d a n O l a h r a g a - U P T T a m a n B i n a B a k a t d a n K o m p e t e n s i S i s w a ( T B 2 K S )

1 0 4 1 0 4 . 0 1

5 . D i n a s K e p e n d u d u k a n d a n P e n c a t a t a n S i p i l 1 0 5

6 . D i n a s P e r i n d u s t r i a n d a n P e r d a g a n g a n - U P T P a s a r

1 0 6 1 0 6 . 0 1

7 . D i n a s K e b u d a y a a n d a n P a r i w i s a t a - U P T D e s t i n a s i W i s a t a

1 0 7 1 0 7 . 1

- 2 -

N O P E R A N G K A T D A E R A H K O D E

W I L A Y A H K E A R S I P A N

i 2 3

8 . D i n a s P e r h u b u n g a n - U P T D P e n g u j i a n K e n d a r a a n B e r m o t o r

1 0 8 1 0 8 . 0 1

9 . D i n a s K o m u n i k a s i d a n I n f o r m a t i k a 1 0 9

1 0 . D i n a s T e n a g a K e r j a d a n T r a n s m i g r a s i - U P T D B a l a i L a t i h a n K e r j a

1 1 0 1 1 0 . 0 1

U . D i n a s P e r i k a n a n 1 . U P T T e m p a t P e l e l a n g a n I k a n 2 . U P T P e r i k a n a n B u d i d a y a A i r T a w a r

1 1 1 1 1 1 . 0 1 1 1 1 . 0 2

1 2 . D i n a s P e r t a n i a n 1 . U P T P r o d u k s i B e n i h T a n a m a n P a n g a n H o r t i k u l t u r a d a n

P e r k e b u n a n 2 . U P T P e l a k s a n a P e n y u l u h P e r t a n i a n

1 1 2 1 1 2 . 0 1

1 3 . D i n a s P e t e r n a k a n d a n K e s e h a t a n H e w a n 1 . U P T R u m a h P o t o n g H e w a n 2 . U P T B u d i d a y a T e r n a k 3 . U P T P u s a t K e s e h a t a n H e w a n

1 1 3 1 1 3 . 0 1 1 1 3 . 0 2 1 1 3 . 0 3

H . D i n a s K o p e r a s i d a n U s a h a M i k r o 1 1 4

1 5 . D i n a s S o s i a l 1 1 5

1 6 . D i n a s K e t a h a n a n P a n g a n 1 1 6

1 7 . D i n a s P e m b e r d a y a a n M a s y a r a k a t d a n D e s a 1 1 7

1 8 . D i n a s L i n g k u n g a n H i d u p 1 . U P T L a b o r a t o r i u m L i n g k u n g a n 2 . U P T P e n g e l o l a a n S a m p a h

1 1 8 1 1 8 . 0 1 1 1 8 . 0 2

1 9 . D i n a s P e r p u s t a k a a n d a n K e a r s i p a n 1 1 9

9 0 D i n n * i P p n a n a m a n M o d a l d a n P o l a v a n a n T e r n a d u S a t u P i n t u 1 2 0

2 1 . S a t u a n P o l i s i P a m o n g P r a j a 1 2 1

2 2 . D i n a s K e l u a r g a B e r e n c a n a , P e m b e r d a y a a n P e r e m p u a n d a n P e r l i n d u n g a n A n a k

1 2 2

D . B A D A N / I N S P E K T O R A T 2 0 0 1 . B a d a n P e r e n c a n a a n P e m b a n g u n a n D a e r a h 2 0 1

2 . I n s p e k t o r a t 2 0 2

3 . B a d a n K e p e g a w a i a n d a n P e n g e m b a n g a n S u m b e r D a y a M a n u s i a 2 0 3

4 . B a d a n P e n g e l o l a a n K e u a n g a n d a n A s e t D a e r a h 2 0 4

5 . B a d a n P e n d a p a t a n D a e r a h 1 . U P T P e l a y a n a n P B B - P 2 d a n B P H T B 2 . U P T P e l a y a n a n P a j a k D a e r a h

2 0 5 2 0 5 . 0 1 2 0 5 . 0 2

- 3 -

iw_x \_/ i_j

r C/K/YIN U i Y A 1 U A c . K A M W I T A Y A H

K F A R S T P A N

t v i j i A i v k i i i m i i i

3

F K F G A M A T A N i \ - J _ J X y i l l Y l Ifc 1 i 111

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