Panchayat:Repo18/vol1-page0833

APPENDIX.A1

FORM OF APPLICATION FOR CONSTRUCTION IN PLOTS PARTS OF WHICH HAVE BEEN SURRENDERED FREE OF COST FOR ROAD DEVELOPMENT

[See Rule 77(1)]

(To b submitted along with the Application for permits)

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

1.	Name of applicant (in Capital letters)	:
2.	Address
	(i) Permanent	:
	(ii) To which Communications are to be sent	:
3.	Details of land surrendered under Rule 77 (1)
	: (i) Details of Town Planning Schemes as per rule 77(1)(a)	:
	:(a) Name of the Town Planning Scheme	:
	:(b) Name of the Road Development Project	:
	:(c) Present state of implementation	:
	:(d) Zoning provisions of the Scheme	:
	:(e) Other provisions of the Scheme	:
	(ii) (a)Name of Scheme applicable as per Rule 77(1)(b)
	:(b) Implementing Agency	:Local Self Government Institution / Development Authority / Government Dept./Quasi Govt. Organisation / Institution / registered Residents Association/Social Welfare Organisation
	:(please specify:....................................... )
	:(c) Present stage of implementation
	(iii) Extent of land in Sq. metres (enclose sketch with all detailed measurements)
	:(a) Total	:
	:(b) Required for implementation of the Scheme in total from the plot	:
	:(c) Surrendered free of cost for the scheme	:
	:(d) percentage of land surrendered	:
	:(iv) Survey No. of surrendered land	:
	:(v) Name of the owner of the land so surrendered	:
	:(vi) Details of relinquishment : (enclose copies of relinquishment)	:
4.	Applicability of Special Provisions

    Item                                Required Permissible as                                           Required/Permissible                                                   Remarks of the
                                             per general provisions                                            as per special provisions                                           special Committee 
Coverage:
F.A.R :
Set backs :
Height :
Parking;