Panchayat:Repo18/vol1-page0833

                                                                                                              APPENDIX.A1

        FORM OF APPLICATION FOR CONSTRUCTION INPLOTS 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;