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

.................................Masterplans/.................................DTPSchemes

Taluk	Village	Survey No	Survey sub division	Area in Ares	Use zone of the master plan	Use zone of the DTP Scheme	Road Widening Proposals	Other proposal, if any	Proposed Use of the buildings