Panchayat:Repo18/Law Manual Page0829

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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                                                        
                                                                                                          -----------------------------------------------------------------------------------------------------------
                                                                                                          Plinth Area                                                                              Carpet Area


Basement/Cellar floor

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


Ground floor

First floor

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

............................... Dashbone Total Area

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