ANNEXURES TO GOMs.NO. 168 MA & UD, DATED: 07.04.2012

338APPENDIX - I………………….(ULB)BUILDING PERMISSION APPLICATION FORMFILE No. Date: ___.___._______To,The Commissioner,……………………………………………..(ULB),…………………………………………….AADDRESS OF THE APPLICANT(Use CAPITAL LETTERS only)1 Name2 Door No./Flat No.3 Road/Street4 Village & Mandal5 City/ Town6 District PIN7 Phone / Mobile No.8 e-mailBLOCATION OF THE PROPOSED SITE1 Plot Nos.2Sanctioned Layout No. /LRS No.3 Survey No./Village4 Premises / Door No.5 Road/ Street6 Ward No./ Block No.7 Locality8 Circle/ Division9 City/ Town/ DistrictCDETAILS OF THE PROPOSED CONSTRUCTION1Site Area(in Sq. m)(a) As perDocuments(b) As per submittedPlan(c) Road WideningArea(d) Net Area2No. ofFloorsCellar Stilt Ground Upper Floors Total3 Floor Area (in Sq.m)4 Parking floor area5 Use of the BuildingIndividual Residential/ Group Housing/ Commercial/ Institutional/ Row Housing /Others (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _