Panchayat:Repo18/Law Manual Page0829

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

             (1) Division of plot

             (ii) New construction

             (iii)Reconstruction

             (iv) Alteration

            (vi)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 Numbers                                                                                  :

                   (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

---

Floor                                                                                                   Area in sq.metres                                                         Carpet Area
                                                                                                        ----

Plinth Area Basement/Cellar floor (ii) (v)

Ground floor First floor Dashbone Total Area

Inserted by S.R.O. No. 26/2014, w.e.f. 13-1-2014.