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APPLICATION FOR LAND DEVELOPMENT PERMIT

FOR OFFICE USE
APPLICATION NUMBER
Y / Y / Y / Y
/ D / D / M / M / Y / Y / Y / Y
RECEIVED
FEE PIAD (Rs):
1 / APPLICANTDETAILS
Name:
Door No.
Flat No.
Building Name:
Road / street name
Locality name
 Village
 Town
Mandal
District
Pin code No.
Mobile No.
Email:
Adhaar No.
Aadhaar card attached

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2 / CADASTRAL DETAILS (REVENUE RECORD)
Location / RSR / Adangal / Pattadar details / Attachments
District / Mandal / Revenue village / Sy.
No. / Letter / Total Extent in Ac. / Sy.No / Sub Divn No / Total extent
in Ac / Name, Aadhaar no. / Extent in Ac
[NNN.NNNN] /  RSR
 FMB
 Title Deed
Pattadar Passbook
 RSR
 FMB
 Title Deed
Pattadar Passbook
 RSR
 FMB
 Title Deed
Pattadar Passbook
Total / Total / Total
3 / REGISTRATION DETAILS
Vendee name,aadhaar no. and aadhaar card attachment / Vendor name aahdaar no. and aahdaar card attachment / Document Number / Date of registration / Location / RSR sy. no. and letter no. / Extent in Ac. / Schedule of Boundaries / Conveyance type / Attachments
Dist / Mandal / Revenue village
As per registration dept. format / dd-mm-yyyy / [dropdown list from adangal] / NNN.NNNN / North:Name, sy.no &sd no.
South:
East:
West: / Registered sale deed
Registered GPA
Registered will
Registered gift deed
Tehsildar certificate for inherited property
 Registered lease / Current document
 Link documents
 13 year EC
North:
South:
East:
West: /  Registered sale deed
 Registered GPA
 Registered will
 Registered gift deed
Tehsildar certificate for inherited property
 Registered lease /  Current document
 Link documents
 13 year EC

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4 / PROJECT DETAILS
Usage of the Layout:  Residential  Commercial  Industrial  Institutional
Project name: / Project cost (Rs): / Project duration (months):
Area in Acres / Percentage
Site / NNN.NNNN / NN.NN
Roads / NNN.NNNN / NN.NN
Park / NNN.NNNN / NN.NN
Utilities / NNN.NNNN / NN.NN
Layout centre (local conveniences) / NNN.NNNN / NN.NN
School / NNN.NNNN / NN.NN
Agricultural produce area
(Applicable if > Ac.20 ) / NNN.NNNN / NN.NN
Plotted area / NNN.NNNN / NN.NN
5 / DCR COMPLIANCE DETAILS
 required width of approach road exists (9m for residential use or 12m for other uses)
Existing land use /  Land falls in agricultural zone as per master plan. If yes,
 land falls wholly within 500 m of existing village settlement
 residential use is permissible as per master plan
Plans and document attachments /  Key plan (1:10000)
Geo-referenced topo planor google map (1:2000) within 100 m from site boundary
Contour plan (1:400) if undulated terrain
 Combined FMB sketch for the total site proposed
Latest survey plan (1:400 scale)
 4 prints of physical layout plan (1:400) and autocaddrawing in CD or online attachment
Infrastructure plan
 Design brief
CLEARANCES FROM OTHER AGENCIES, IF REQUIRED
Irrigation canal crossing /  Approach road is canal bund /crossing the canal. If yes,
 NOC issued by Irrigation department is submitted
Railways / Distance between railway and plan boundary is < 30 m but NOC of railways is attached
Electric lines / Certificate from APSPDCL regarding alignment of future electrical lines.
Airport / The site is falling in Air funnel zone but clearance from AAI is attached.
Oil and gas pipe lines /  Oil / gas pipe line passes through the site or touches the site boundary and but No objection certificate from respective authority enclosed.
Protected monument / heritage structures / Layout location is > 100 m and < 200 m from protected monument/ structure and clearance from National Monuments authority exists.
Environment clearance /  Extent is ≥ 123.50 Acres. If yes,
 Clearence from State Environmental Impact Assesment Authority, Ministry of Forests and Environment, GOI.
Clearance from
RDO/Sub collector / Proceedings of RDO/ Sub collector regarding conversionof land to Non-agricultural use under APAL Act- 2006
6 / LICENSED PERSONNEL DETAILS
Name & Address / License No.
Developer / NNNN/YYYY
Applicant is not licensed developer. If yes,
attachedregistered agreement entered between owner and developer.
Town Planner / NNNN/YYYY
Engineer / NNNN/YYYY
7 / DECLARATION

I/ we have gone through the Layout rules made under the provisions of APCRDA Act and have satisfied myself/ ourselves that the site and layout plans are in accordance with provisions contained therein. We agree to confirm to all applicable laws of this jurisdiction. In addition if a permit for work desirable in this application is issued, we certify that the concerned officials or authorized representative shall have the authority to enter areas covered by such permit at any reasonable hour to enforce the provision of Law applicable to such permit. I/we certify that all information provided in this form is true and any misrepresentation or suppression shall lead to cancellation of permission and prosecution under law.

Sl.No. / Person / Name / Signature
1. /  Owner
 Lessee
 Authorized Agent
2. / Developer
3. / Town Planner
4. / Engineer