Panchayat:Repo18/vol1-page0831

APPENDIX-A

[See 7(1) and 134 (1)]

....................................................Panchayat

APPLICATION FOR PERMIT / REGULARISATION

1.	Name in Capital letters	:
2.	Address	:
	(i) Permanent	:
	(ii) To Which Communication are to be sent	:
3.	Nature of development/construction	:
	(i) Division of plot	:
	(ii) New construction	:
	(iii) Reconstruction	:
	(iv) Alteration	:
	(v) Addition/Extension	:
	(vi) Digging of well	:
	(vi.a) Hut	:
	(vi.b) Compound wall	:
	(vii) Change in occupancy	:
	(viii) Erection of Telecommunication tower /other structure	:
	(ix) Demolition	:
4.	Details of plot	:
	(i) Survey Number	:
	(ii) Extent	:
	(iii) Nature of ownership	:
	(iv) Number and date of deed / document	:
	(v) Registrar's Office	:
	(vi) Sub Division	:
	(vii) Ward Number	:
	(viii) No. of the nearest building	:
	(ix) Revenue Village	:
	(x) Taluk	:
	(xi) District	:
5.	Occupancy	:
	(i) Residential Group A1	: ........................................
	(State the number of dwelling units also)
	(ii) Non residential/Others (Please specify)	: ........................................
6.	Whether Government or Quasi Government	:
7.	(i) Plinth area of the proposed building	:
	(ii) Details	:

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FIoor	Area in sq.metres
	Plinth Area	Carpet Area

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Basement/Cellar floor:

Ground floor :

First floor:

.....................

.....................

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Total Area:

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