Sdgx cG]lG

rAeG; 24136&-G;t1&07&fcI.i; fp\SpC cIuA .gn (-G;t) idke\e[\

fjgkirr\fekgA[ fJufj; 20%6%2007;

cG]khG

1; eB\vluf\fkdX]k alYfaluj >lPdal]kr\r Sdgxl eB\vluf\f\

sd}jm rjGa\aln v}b\bX goeA rHdj cG]lG Yel>hUf\fjH -
]kr\rfkisg Sdgxl akrjcje\elhjMj >jH/jAz\ yoXc\ 1999%r\
Lrkc{faluj alYfSa sd}jm rjGa\aln LSed\, egjSClPjv\v\ >jH/jAz\
seGajM\ rHdlio;

2; th\hl eB\vluf\fkdxjhkA Lrk>r\Paluj dlnjv\vjgj]kr\r

(AppendixI) SElajH >jH/jAz\ -e\xjS],R gwjc\MG
Kn\mlujgjS]n\mfkA[ gwjc\MG eoGn\naluj eogje\ejS]n\m fkaln\;
gwjc\MyjsRy th\hl SewkdxjhkA cJgjuH rAeG
Kn\mlujgjS]n\mfkA[ Sewkdxksm rAeG gwjc\MyjsRy -pU SewjH
fr\sr dlnjv\v\ scYd}yj cG}jssE svu\Sun\mfkaln\;

3; >jH/jAz\ -e\xjS],R th\hl YeiUf\fj pjicb\bxjhkA

cIJdgjS]n\mfln\; LSed\, akRznrl Ydaf\fjH cIJdgjS]n\mfkA
Lfjr\ ssde\eM\ gcJf\ (AppendixII) rHSdn\mfkaln\;
ssde\eM\ gcJfjH LSed\, -gjH rjr\rln\ ssde\eMjusfr\rkA[
tr\rln\ ssde\eMjusfr\rkA iUd\faluj dlnjv\vjgj]nA; domlsf
>jH/jAz\ seGajM\ |fk pjicaln\ SCDgjS]n\msfr\rkA
iUd\falujgj]nA; gcJfjH cJgjuH rAeG Kn\mlujgj]nA;

4; sd}jm rjGa\alnf\fjrkxx LSed\, sd;tA;>j;-G;%H LrkClcj]kr\r

gJfjujhkxx YeSfUd Elyf\fjH -ujgj]nA; Elyf\fjsRy alf{d
TSflsmle\eA Lrk>r\Paluj SvG]kr\rk (AppendixIII);

5; LSed\,l Elyf\Sflme\eA ssdiClidlCA sfxjuj]kr\r SgDukA[

dgamv\v gcJfkA[ e\xlrkdxksm aor\r\ Sdle\ejdxkA Kn\mlujgjS]n\mfln\;
LSed\, Elyf\fjhkA[ e\xlrkdxjhkA LSed\,drkA[ sshcRcjukA
Qe\ejSmn\mfln\; sd}jmf\fjsRy e\xlR ijijP dmhlckdxjhluj
igv\v\ do}jSulwje\ejv\v e\xlrkdX cIJdgjS]n\mfjh\h;

6; sd}jm rjGa\aln v}f\fjH d\xlc\ h.jv\vj}kxxfkA[ v}A ssddlgUA

svu\ukilR Lyjulikr\rfkalu tB\vjrJuG YeFapU,\mUl 5%lA
 2

Dn\/jdujH eyukr\r SgDdX th\hlA egjSClPjv\v\

Kye\ekigkf\Sfn\mfln\; tB\vJrjuG Th\hlf\f eB\vluf\fkdxjH
QliGcjuG egjSClPr rme\elS]n\mfln\; tB\vjrJuykA[ QliGcjuykA
Th\hlf\f eB\vluf\fkdxjH eB\vluf\fk scYd}yj SgDddX
egjSClPjS]n\mfln\;

7; >jH/jAz\ yoXc\ YedlgA |sfb\djhkA YePlr c\Fhf\fk rjr\rkA e\Sxl}\

c\Fjfjsvu\ukr\r c\Fhf\sf dlnjv\vksdln\mkxx e\xlR (ShlS],R
e\xlR)[ c\Fhf\fjSRyukA SvGr\rk djm]kr\r Syl/kdxkSmukA ijCpalu
LxikdX (sscM\ e\xlR)[ rjGa\aj]kilR Kp\SpCj]kr\r sd}jmf\fjsRy
goeSgD(>jH/jAz\ e\xlR)[ sd}jmf\fjsRy YePlr .lzf\sf Dn\/jv\vk
sdln\mkxx ijCp ijigb\bX (scd\,R)[ sd}jmf\fjsRy akRdlq\v
(thjSi,R) tr\rji iUd\faluj e\xlrkdSxlsmle\eA
dlnjv\vjgj]nA;

8; e\xlrkdxjsh LxikdX iUd\fikA d{fUikA -ujgj]nA;

9; rjGa\alnA rmf\fkilR Kp\SpCj]kr\r c\FhA fJgSpCegjelhr rjuaA

>lPdal]juj}kxx c\Fhf\f\ KXe\se}j}kxxflsnb\djH Li domj
egjSClPjv\v SC,Sa >jH/jAz\ seGajM\ rHdlio;

10; mON e\xlrjAz\ ep\PfjdX >lPdal]juj}kxxx eB\vluf\fkdxjH

Li domj egjSClPjv\vSC,A alYfSa seGajM\ rHdkilR elmkxxk; mON
e\xlrjAz\ ep\Pfj >lPdal]juj}kxx c\Fhf\sf ep\Pfjdxksm
ale\ekdxkA Li rjur\Yfj]kr\rfjrkxx SgDdxkA wjh\hl mON e\xlrGalG
eB\vluf\fk scYd}yj]\ rHSdn\mfkA[ ep\Pfjdsx]kyjv\vkxx
eoGn\n ijigA scYd}yjalG]\ ijCpJdgjv\vk rHSdn\mfkaln\;

11; elmA rjdf\fjSul[ ihju SflfjH .oaj Tmjv\vk rjdf\fjSul dkqjv\Svl

sd}jmA rjGa\aj]kilR Kp\SpCj]kr\rksib\djH yirUo /jij,R
QlEJcyksm akRdoG Lrkafj ilb\bjujgj]nA;

12; rjGa\alnA rmf\fkilR Kp\SpCj]kr\r c\FhA an\njmjv\vjShl[

sixxe\sel]Sal[ LedmSal, -SglzUf\fjr\ <lrjdgalu
dlgUb\bSxl igkf\fkdujh\hl tr\r\ Kye\ek igkf\fjs]ln\m\ .oaj
ijdcr seGajMkA >jH/jAz\ seGajMjSrlsmle\eA scYd}yj
rHSdn\mfln\;

13; sycj/R,UH sd}jmb\bxkA[ sycj/R,UH dlMzyjujH semlf\f

sd}jmb\bxkA YeSfUdA egjSClPjS]n\mfln\; 150 v; aJMG isg
 3

e\xjr\f\ |gjulukxx sycj/R,UH >jH/jAzjr\ c\Ydo}jnj svu\ukr\r

pjicA fr\sr rjualrkc{falsnr\rk dn\mlH seGajM\
rHSdn\mfln\; e\xlrjH eyukr\r dlgUb\bX rjualrkc{falsnr\r\ 30
pjicf\fjrdA c\Fh egjSClPr rmf\fj eB\vluf\f\ KSpUlzc\FG
Kye\ek igkf\Sfn\mfln\; tr\rlH 150; v; aJMyjH domkfhkxx
sycj/R,UH sd}jmb\bX]kA[ sycj/R,UH dlMzyjujH
KXe\semlf\f aM\ th\hl sd}jmb\bX]kA c\Fh egjSClPr]\
SC,A alYfA seGajM\ rHdjulH afjuldkA;

14; sd}jm rjGa\aln v}A (sd;tA;>j;-G;%1999) Lp\PUluA VII%H

rj,\dG,jv\vjgj]kr\rfkA[ selfk KeSulzf\fjrkSin\mj rjGa\aj]kr\rfkalu
c\doxkdX[ -CkeYfjdX[ QlEJckdX[ selfk wrb\bX Qr\rjv\vk domkr\r
c\Fhb\bX[ iUliclu c\Flerb\bX[ cA.gn c\Fhb\bX[ Ledm
clp\PUfukxx ic\fk]X ssddlgUA svu\ukr\r sd}jmb\bX tr\rji]\
c\Fhf\fjsRy KeSulzf\fjrkA[ sd}jmb\bxksm ijrUlcf\fjrkA
(Usage of Plot and Lay Out Approval) LAzJdlgA ilb\Sbn\mfln\;
SaHe\eyB\B LAzJdlgA 0;5 s<d\myjH dkySil 500 v; aJMyjH
dkySil -snb\djH wjh\hl mON e\xlryjH rjr\rkA 0;5 s<d\myjH
domkfhlu c\Fhf\fkA 500 v; aJMyjH domkfH >jH/jAz\
|gjulukxx c\Fhf\fkA vJE\ mON e\xlryjH rjr\rkA LAzJdlgA
ilb\Sbn\mfln\; Yec\fkf LAzJdlgA h.jv\vSC,A alYfSa >jH/jAz\
seGajM\ rHdlio;

15; LSed\, h.j]kr\r aky]\ akRznrl Ydaf\fjH alYfA seGajM\

rHSdn\mfln\;

16; >jH/jAz\ yoXcjH eyukr\r dlhliPjulu 30 pjicf\fjrdA seGajM\

rHSdn\mfln\;

17; |sfb\djhkA dlgnf\flH LSed\, rjgcj]kr\r ed\,A dlgnA

c<jfA Qglq\v]dA LSed\,dsr LyjujS]n\mfln\(AppendixIV);
e\xlrjhkA LSed\,ujhkA rUorfdX Kxx ed\,A LfkA LSed\,dsr
LyjujS]n\mfln\ (AppendixV);

18; >jH/jAz\ yoXcjH eyB\Bjgj]kr\r YedlgA c\Ydo}jnj EJc\

LSed\,drjH rjr\rkA TOmlS]n\mfkA[ Yec\fkf EJc\
eB\vluf\fjsRy igkalraluj dn]lS]n\mfkaln\; EJc\ TOml]kASelX
fJufjukA ijCp ijigikA dlnjv\vksdln\mkxx gcJf\ rHSdn\mfln\;
 4

19; >jH/jAz\ seGajM\ sd}jm rjGa\aln rjuaf\fjH dlnjv\vjgj]kr\r

YeSfUd SElajH rHdjujgj]nA; seGajMjSrlsmle\eA Qgk e\xlR
LAzJdgjv\v\ LSed\,drk rHSdn\mfln\; LSed\,dR LAzJdgjv\v
e\xlrjr\ Lrkc{faluj rjGa\alnA rmf\Sfn\mfln\;

20; c\Fh egjSClPrl cauf\f\ LSed\,dR caGe\ejv\v e\xlrkdxksm

Sdle\ejdxkA[ SgDdxkA (Kmac\FlidlCA sfxjuj]kr\r SgDukA[
dgamv\v gcJfkA)[ domlsf ijCpalu egjSClPr]\ -
iCUalu cGi\Si c\sdv\vkdxkA egjSClPrl KSpUlzc\FR iCA
Kn\mlujgj]nA;

21; c\FhegjSClPr]\ KeSulzj]kr\r Sme\ekdX eoGn\n LxikdX

Kxxflujgj]nA;

22; rjGa\alnf\fjrk akRekA rjGa\alnA rmr\rksdln\mjgj]kASelqkA c\Fh

egjSClPr rmf\Sfn\mf\ LSed\,dsRy clr\rjp\PUf\fjH -
ujgjS]n\mfkA[ LxikdX LSed\,dsr S>lp\PUe\semk f\Sfn\mfkaln\;

23; sfMluj e\xlR caGe\ejv\v\ rjGa\alnlrkafj ilb\bjufluj

scYd}yjuksm YCp\PujH se}lH ijCpJdgnA -iCUe\se}\ Srl}Jc\
rHdj sfM\ S>lp\PUe\semkr\r ed\,A seGajM\ yp\pk svu\unA;
T]lgUf\fjH LSed\,drkA[ e\xlR igv\v\ fu\ulyl]j rHdkr\r
sshcRcjukA Kf\fgilpjdxlujgj]kA; LYedlgA e\xlR fu\ulyl]j
caGe\ej]kr\r sshcRcjsu dkyjv\vkxx ijCp yje\SelG}\ Qglq\v]dA
gwjc\Myjb\b\ LSflyjMjsu (rzgdlgU /uyd\msy) Lyjuj]kdukA svu\unA;

24; LAzJdgjv\v e\xlrjr\ ijgkp\Paluj rjGa\aln YeiGf\frA rmf\fkdukA

tr\rlH sd}jm rjGa\aln v}A hAZj]lfjgj]kdukA svu\ukdulsnb\djH
yjssic\/\ e\xlR eB\vluf\fjH rHdj yjssic\/\ seGajM\
ilb\Sbn\mfln\;

25; seGajM\ ilb\bjuSC,A sd}jm rjGa\aln v}A hAZjv\v\ rjGa\aln

YeiGf\frA rmf\fkr\red\,A Li LrPjd{faluj dn]l]j Lfjrkxx
rmemj cIJdgjS]n\mfkA[ eB\vluf\f\ s/eUo}j /uyd\mG[
eB\vluf\f\ /uyd\mG tr\rjisg LyjujS]n\mfkaln\;

26; >jH/jAz\ seGajM\ rHdkr\r&rjgcj]kr\r th\hl LSed\,dSxukA

dkyjv\vkxx ijigb\bX th\hl alcf\fjShukA Qr\rlA fJufjukA 16%lA
fJufjukA eB\vluf\f\ s/eUo}j
 5

/uyd\mSyukA[ wjh\hl mON e\xlrjAz\ QlEJcSyukA

Lyjujv\vjgjS]n\mfln\ (AppendixVI); Lijsm rjr\rkA Email%H
eB\vluf\f\ /uyd\mSyukA[ fp\SpC cIuA .gnidke\e\
scYd}yjSuukA LyjujS]n\mfln\;

27; eB\vluf\f\ s/eUo}j /uyd\mykA[ wjh\hl mONe\xlrykA domj SvGr\r\

th\hl alcikA cGssYec\ sv]k rmf\Sfn\mfkA[ LrPjd{falu
rjGa\alnf\fjsrfjsg rmemj cIJdgj]kdukA[ ijCpalu yje\SelG}\
eB\vluf\f\ /uyd\mG]kA[ fp\SpC cIuA .gn idke\ek
scYd}yj]kA rHSdn\mfkaln\ (AppendixVII);

28; sd}jm rjGa\alnA rmf\fkASelX LAzJdgjv\v e\xlrjsRy Sdle\ej rjGa\aln

c\Fhf\f\ cod\,jS]n\mfkA[ eB\vluf\f\ mON e\xlrjAz\
idke\ejsh KSpUlzc\FG[ cG]lG rjGp\SpCj]kr\r KSpUlzc\FG[
cGssYec\ mJA LAzb\bX c\FhA egjSClPj]kASelX Li
egjSClPr]\ rHSdn\mfkaln\;

29; sd}jm rjGa\alnA eoGf\fjuluj dqjukASelX Kmac\FR sshcRcjuksm

LAzJdlgf\Sflmkdomj rHdkr\r dAe\xJ,R e\xlR egjSClPjv\v SC,A
LSed\,dr\ Ql]ke\eRcj cG}jEj]M\ rHSdn\mfln\;

30; sd}jm rjGa\aln v}A hAZjv\v\ >jH/jAz\ seGajM\ rHdkdSul[ Yec\fkf

seGajMjsRy Lmjc\Flrf\fjH rjGa\alnA rmf\fkr\rflSul cG]lgjsRy
YCp\PujH se}lH Lfjrkxx eoGn\n Kf\fgilpjfIAikA[ Lfjrkn\mldkr\r
r,\mf\fjrkA scYd}yj Kf\fgilpjulujgj]kA; domlsf scYd}yjuksm
SegjH Cjd\,n rmemj cIJdgj]kr\rfkalujgj]kA;

II. rjGa\alnA rmr\rksdln\mjgj]kr\r sd}jmb\bX;

1; v}A >lPdal]js]ln\mkxx Kf\fgi\ 6%6%2007%H Yel>hUf\fjH ir\rk;

Tf\ scYd}yj Srl}Jc\ S>lG/jH YepGCje\ejS]n\mfln\; domlsf
selfkwrb\bxksm LyjijSh]\ eYfb\bX&hZkShDrb\bX tr\rji
akSDrukA LyjujS]n\mfln\;

2; 1%3%2007 akfH tR;Q;cj; h.jv\vfkA[ Lh\hlsfukA rjGa\alnA

rmr\rfkalu sd}jmf\sf]kyjv\vkxx th\hl ijigb\bxkA
 6

ShlS],R e\xlR[ sscM\ e\xlR[ >jH/jAz\ e\xlR[ scd\,R[

thjSi,R[ e\xjr\f\ |gju[ rjhdxksm tn\nA[ tE\;t;-G;[ Coverage
c<jfA eB\vluf\f\ scYd}yj SCDgjS]n\mfln\; domlsf
sd}jmf\fjsRy Te\Selqf\sfc\Fjfjsu]kyjv\v\yjukr\rfjr\
sd}jmf\fjsRy eh pjCdxjH rjr\rkxx SElS}lukA
SCDgjS]n\mfln\;

3; 1%3%2007 akfH tR;Q;cj; h.jv\vkA Lh\hlsfukA rjGa\alnA rmr\rk

sdln\mjgj]kr\r th\hl sd}jmb\bsx]kyjv\v\kxx akqkiR ijigb\bxkA
YeSfUd gwjc\MyjH SgDe\semkf\Sfn\mfkA[ rjGa\alnf\fjsRy
c\Fjfj[ LSrI,n KSpUlzc\FR (tB\vjrJuG&QliGcUG) c\Fh
egjSClPr rmf\fj fJufj c<jfA cG}jssE
svu\Sun\mfkaln\; TO ijigb\bX fp\SpC .gn idke\e\
scYd}yj[ eB\vluf\fk /uyd\mG[ wjh\hl mON e\xlrG[
eB\vluf\fk s/eUo}j /uyd\mG tr\rjigksm LyjijSh]luj
ijigb\bX SCDgjv\vfjrkSC,A 15 pjicf\fjrdA Luu\S]n\mfln\;
gwjc\MyjH -iCUalu ijCplACb\bX Lrk>r\Paluj SvG]kr\rk
(AppendixVIII)

4; tR;Q;cj; h.jv\vfkA[ tr\rlH rjGa\alnA -gA.jv\vj}jh\hlf\ffkalu

sd}jmb\bX sd;tA;>j;-G; YedlgA rjGa\alnlrkafj ilb\bj alYfSa
rjGa\aj]kilR elmkxxk;

5; tR;Q;cj; ilb\bjv\vj}kxxfkA[ tr\rlH Ground Level%r\ akdxjSh]\

rjGa\alnA -gA.jv\vj}jh\hlf\ffkalu sd}jmb\bX]\ sd;tA;>j;-G;
>lPdal]j seGajM\ rHdj alYfSa rjGa\alnA Lrkipj]lio;

6; c\Ymd\v\vyjsRy enj eoGf\fjul]jufkA tr\rlH Tfkisg rAeG

h.jv\vj}jh\hlf\ffkalu sd}jmf\fjr\ EJc\ >lPdalujgj]kA;

7; .lzjdaluj rjGa\alnA eoGf\fjul]ju sd}jmb\bX egjSClPj]kASelX

ckgd\,l cAijPlrf\fjrkA[ (taGwRcj c\sMuGSdc\) elG]jAzjrkA
c\FhA rHdjuj}jh\shb\djH Li rme\el]kr\rfjr\ c\FhA Kxx ed\,A
scYd}yjrme\elS]n\mfln\; aqsixxs]lu\f\fjrkA (Rain Water
Harvesting) YeSfUd cAijPlrA |Ge\semkf\fnA;

8; selfkwrb\bxkaluj >r\Pakxx sd}jmb\bxjH LAzssidhUakxxiG]\

ylAe\[ Smlu\hM\[ dlGelG]jAz\ tr\rji rHdjujgj]nA;
 7

9; Dn\/jd II (2)%sh sd}jmb\bxksm ijigb\bX dn]jshmkf\f\

>l]jukxx rjGa\aln YeiGf\frf\fjr\ c\Ydo}jnj EJc\
TOmlS]n\mfln\;

10; rjGa\alnA rmf\fjsdln\mjgj]kr\r sd}jmf\fjH tR;Q;cj; h.jv\vfjhkA

domkfhluj rjGa\alnA rmf\fkilR Kp\SpCj]kr\rksib\djH Li sd}jm
rjGa\aln v}f\fjr\ Lrkc{falsnb\djH alYfA LrkilpA
rHdlikr\rfln\;

11; Sh QO}\ LAzJdlgA domlsf ihjuSflfjH rjGa\aln YeiGf\frikA[ .oaj

ijdcrikA rmf\fkr\r e\Sxl}kmadX]\ Srl}Jc\ rHSdn\mfkA[
s/ihe\e\saRy\ seGajMkA >jH/jAz\ seGajMkA ilb\bjuSC,A alYfA
fkmGr\r\ rjGa\alnA rmf\fkr\rfjr\ rjGp\SpCA rHSdn\mfkaln\;

sd}jm rjGa\aln v}b\bX cA>r\Pjv\v\ cACub\bX Kxx ed\,A wjh\hl

mON e\xlrGalsg caJejS]n\mfln\;
mj; sd; Swlc\[
scYd}yj[
fp\SpC cIuA .gn idke\e\;
1) rzgdlgU /uyd\mG[ fjgkirr\fekgA;
2) eB\vluf\f\ /uyd\mG[ fjgkirr\fekgA;
3) vJE\ mON e\xlrG[ fjgkirr\fekgA;
4) SdlGe\eSy,R scYd}yj[ fjgkirrf\ekgA[ sdlh\hA[ sdlv\vj[ f{CoG[
SdlqjS]lm\;
5) cJrjuG mON e\xlrG[ ijwjhRc\;
6) td\cjdUo}Ji\ aj,R /uyd\mG[ TREGSa,R Sdgx aj,R[ YefJd\,
mOSiq\c\[ elb\be\ely[ fjgkirr\fekgA; 695581; (fp\SpC cIuA .gn
idke\ejsRyukA aM\ cG]lG si>\sscMkdxjhkA Yecjp\PJdgj]kr\rfjr\);
7) e>\xjd\ yjSh,Rc\ /uyd\mG (eYfalp\PUab\bxjhosm -iCUalu
e>\xjcjMj rHdlR rmemjsumkS]n\mfln\);
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fp\SpC cIuA .gn idke\e\ ar\Yfjuksm ssYeiM\ scYd}yj]\
fp\SpC cIuA .gn idke\e\ YejRcje\eH scYd}yjuksm ej;t;u\]\;
fp\SpC cIuA .gn idke\e\ scYd}yjuksm cj;t u\]\;
s/eUo}j scYd}yjuksm cj;t; u\]\;
fp\SpC cIuA .gn idke\e\ (-G;>j[ -G;cj[ idke\ed \ X]\);
fp\SpC cIuA .gn idke\e\ (-G;t2[ -G;t;3) idke\ekdX]\
c\SMl]\ EuH&QlEJc\ Sdle\ej;
Kf\fgijR YedlgA
Sd/
scd\,R QlEJcG;
 AppendixII

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 APPENDIX III *
(See Rule 5 (1) and Rule 144 (1))

Grama Panchayat.

APPLICATION FOR PERMIT/REGULARISATION

1. Name (in capital letters):

2. Address:

(i) Permanent
(ii) To which communications
are to be sent

3. Nature of development/construction:

(i) Division of plot

(ii) New construction
(iii) Reconstruction
(iv) Alteration
(v) Addition or extension
(vi) Digging of well
(vii) Change in occupancy
(viii) Erection of Telecommunication tower
or other structure.
(ix) Demolition

4. Details of plot

(i) Survey No.

(ii) Extent
(iii) Nature of ownership
(iv) Number and date of deed/
document
(v) Registrar's Office
(vi) Sub Division
(vii) Ward No.
(viii) Number of the nearest building
(ix) Revenue village
(x) Taluk
(xi) District
5. Occupancy.

(i) Family residential:

(State whether it is for one or
two or for more family use)
(ii) Nonfamily residential building
(iii) Others (Specify the occupancy)

6. Whether Government or Quasi

Government.

7. (i) Plinth area of the proposed building

(ii) Details

Area in Sq.metres
Floor Plinth area Carpet area

Basement or cellar floor

Ground floor

First floor

Total Area

8. Height of building in metres:

(i) From ground level with and without

Stair room, machine room etc.

(ii) From street level with and without

stair room, machine room, etc.

9. If the application is for regularisation:

(i) Whether completed or not

(ii) If not completed the state of

construction.

10. Details of permit/approved plan

already obtained.
11. Details of fee paid:

(i) Amount

(ii) No. and date of receipt

12. Details of documents, plans, certificate,

etc. enclosed.

Declaration

I,hereby declare
that the measurements, specifications and other details and specifications mentioned
above are correct, complete 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 with name

Date:

13. CERTIFICATE

Certified that the site plan is prepared after verification of ownership document and
site and the measurements shown are found to be correct.

Signature:

Name:
Reg.No.:
Place: Address:
Date: (Registered Architect, Engineer,
Town Planner, Supervisor)
14. CERTIFICATE

Certified that the building plan is prepared in accordance with the provisions in the
Kerala Municipality Building Rules, 1999, Kerala Municipality Act, 1994 and the
provisions contained in sanctioned Town Planning Schemes.

Signature:
Name:
Reg.No.:
Place: Address:
Date: (Registered Architect, Engineer,
Town Planner, Supervisor)

15. UNDERTAKING

I,..hereby undertake that the building

construction/ land development will be carried on/ being carried on/ was carried on
as per the approved plan and permit in accordance with the rules in force.

Signature:
Name:
Reg.No.:
Place: Address:
Date: (Registered Architect,
Engineer, Town Planner, Supervisor)
* Appendix A of KMBR1999.
 AppendixIV

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 AppendixV

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