Panchayat:Repo18/vol1-page0831

                                                           APPENDIX-A

                                                      [See 7(1) and 134 (1)]

                                            ....................................................Panchayat

                       APPLICATIONFORPERMIT/REGULARISATION

1. Name in Capital letters:

2. Address-
(i) Permanent:
(ii) To Which Communication are to be sent P:

3. Nature of   development/construction-
(i) Division of plot:
(ii) New construction:
(iii) Reconstruction:
(iv) Alteration:
(v) 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 Number:
(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:

    FIoor                                                                Area in sq.metres

                                                                    Plinth Area   | Carpet Area

Basement/Cellar floor:

Ground floor :

First floor:

- - - - - -

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

Total Area: