Panchayat:Repo18/vol1-page0835

(iii) (a) Whether the plot abuts National Highway, State Highway, District Road, or roads notified by Grama Panchayat under section 220 (b) of the Kerala   
              Panchayat Raj Act 1994 (please put Y mark inthe appropriate box): Yes[  ]/ No[   ] 
(b) If yes, the distance of the construction from such  highway/road;................ metres 
(iv) Minimum Setbacks/yards: Front...............................metres     
      Rear:.................................metres 
      Side(1):...............................metres 
      Side(2):..................................metres

7. Details to be included: 
    (i) Copies of proof of ownership (please put ✓ mark in the appropriate box):
          Registered deed ☐ Pattayam ☐ Possession Certificate ☐ 
 (ii) Consent from the owner of neighbouring plot if the construction abuts that plot boundary. 
 (iii) In case, NOC/clearances as specified in rule 133 of the Kerala Panchayat Building Rules 2011 are to be obtained, a site sketch not necessarily to 
       scale signed by the owner, showing plot boundary, outline of the existing and proposed built-up area within the plot, abutting street and width of 
        open yards around is to be enclosed. 

                                                                                               DECLARATION 
 I................hereby declare that, the details mentioned above and enclosed along with are Correct, complete and true to the best of my knowledge and belief and that I shall abide by the provisions contained in rule 113B of the Kerala Panchayat Building Rules 2011.                             
                                                                                                                                      (Signature of the owner with name)
Place: 
Date : 

APPENDIX AA See Rule 5(1), 5(2)

APPLICATION FORM FOR PERMIT FOR DEVELOPMENT/REDEVELOPMENT OF LAND

To
  The Secretary,
  ................................Panchayat.
Sir,
I.........................Intend to develop/redevelop the land in Survey Number..............................of........ .Village in ............. Taluk........................owned by me. I forward  herewith the site plan, service plan and specification in triplicate duly signed by me and by......................... (Name in Block letter of the registered  Architect/Building Designer/Engineer/Town Planner/ Supervisor) having Register No.................... together with the required documents. 
I hereby undertake to abide by the provisions of the Kerala Panchayat Building Rules, 2011 in all respect.
I request that the development/redevelopment may be approved and development permit granted to me.
                                                                                                                                                         Signature
                                                                                                                                                        Name of Owner: 
                                                                                                                                                  (in Block letters)
                                                                                                                                                        Address:
Place:
Date:

APPENDIX-B [see rule 6(7)] DEVELOPMENT PERMIT

                                                                                 .................................Panchayat
No :   ................................................                                                                          Date: .............................
Ref: Application dt....................... from Sri/Smt...............................................................................................

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