Panchayat:Repo18/vol2-page1561

Sir,

I am intending to Construct a ................ (specify the use and OCCupancy) building................Or telecommunication tower/polestructure near/overthebuilding No. ... in Corporation/ Municipality in Survey No................. Village................ Taluk ................ District................

I requesthat concurrence may be accorded to the Secretary. Municipality/Grama Panchayath for permitting the above Construction in the said land. Necessary plans, documents in quadruplicate are enclosed.

STATEMENT OF THE OWNER ( IN OUADRUPLICATE)

1. Land use as per the sanctioned Town Planning Schemes and the proposed use of the building