Panchayat:Repo18/vol1-page0834

                                                        DECARATION
 I...............................hereby declare that the measurements,  specifications and other  details mentioned above are complete,       correct and true to the best of my knowledge and belief and that I shall abide by the approved plan and the provisions in the Act and Rules in undertaking the construction. 
Place:                                            Signature of the Applicant
Date :                                            Name of the Applicant
                                                           
                                    CERTIFICATE
Certificated that the site plan is prepared in accordance with the Kerala Panchayat Building Rules, 2011, Kerala Panchayat Raj Act, 1994, provisions contained in the Town Planning Schemes and road development proposals of the implementing agency.
                                                                     Signature
                                                                     Name

Place: Reg.No. Date : Address (Registered Architect/ Engineer/ Town Planners Supervisor)

                                            <big>APPENDIX-A2 
                                         (see rule 133)
                                                PROFORMA 
Intimation of intention to carry out construction/reconstruction/addition/alteration (as per rule 133 of the Kerala Panchayat Building Rules, 2011)

, . να ανllage, ταTaluk

1. Name of owner in Capital Letters

2. Address

(i) Permanent (ii) To which communication is to be sent (iii) Telephone/Mobile Number

3. Nature of development/Construction (please put Y mark in the appropriate box)

(i) Hut []
(ii) New construction []
(iii) Reconstruction []
(iv) Alteration[]
(v) Addition / Extension[]

4. Details of plot: 
(i) Survey Number:................................ of...........................................village 
(ii) Extent . . ....................
(iii) Nature of ownership : .....................................................
(iv) Building No: of the nearest building : .....................................................    
 (v) Nearest road junction or landmark : ...................................................

5. Occupancy (please put Y mark in the appropriate box). 
(i) Residential Group A1 []
(ii) Non residential/Others[] (Please specify...........................................)

6. (i) Total built-up Area of the building in sq.metres

                          existing.......................................         
                          proposed...................................... 
                          Total...............................................
  (ii) Total number of floors : ..............................