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