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

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Item

Required Permissible as per general provisions

Required/Permissible as per special provisions

Remarks of the special Committee

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Coverage :

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F.A.R :

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Set backs :

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Height :

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Parking :

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ഈ താൾ 2018 -ലെ പഞ്ചായത്ത് റെപ്പോ നിർമ്മാണം യജ്ഞത്തിന്റെ ഭാഗമായി സൃഷ്ടിച്ചതാണ്.