1. Name of the local body :

2. Date of receipt of the application :

3. Name of the Local Planning Authority :

4. Applicant Name & Address

  (with pincode) :

5. Layout by/Private/TNHB/ Co-operative society/Others :

6. Ownership particulars - The Ownership of land by:

                   i) Inheritance/partisan/sale deed/others :

                   ii) Sale deed (details) :

                   iii) Power agent (details) : 

7. Site particulars:-

i) S.F.No./R.S.No. :

ii) Block No./Ward No. :

iii) Village name :

8. Extent of land:- 

a) Total area :

b) No. of plots required :

c) Size of the plot required:-  

               i) Minimum size width :

               ii) Maximum size/wodth :

               iii) Minimum size extent :

               iv) Maximum size extent :

d) Sale of plots if any in the proposed layout:- Yes / No 

If yes, the area should be shown separately  with distinct colour marking and annexing the xerox copy of the sale deed, copy of plot/plots with separate colour marking.

9. Is the layout is a proposed new one or revision of the approved layout (part/total) If there is revision, give DTCP’s approval reference number and Map No. and reason for revision.

10. The topo sketch to a radius of 90 metres (300ft) around the boundary of the site indicating the existing developments in and around the surrounding area ahould be annexed. 

Give Yes or No for the following questions.

             a) Major building and their uses and major land use (wet/dry)

             b) Burial/cremation ground:

             c) Railway line

             d) Water bodies like tank, channels river etc.

             e) LT or HT line :

             f) Prohibited Area :

             g) Airfields/run way etc. :

             h) Declared heritage area :

             i) Quarrying/mining :

             j) Coastal area-layout lies in between :

             k) 200m to 500m : 

11. Whether the layout land lies in the declared area of residential and industrial other than the Master Plan, D.D.Plan residential/industrial area. :

12. Approach road details for the proposed layout

  i) Name of the road :

  i) Width of the road :

  iii) Nature of the road : Tar/WBM/MUD

  iv) Name of the connecting major road :

I. Length of approach road with reference to major road :

II. Type and ownership of the approach road:- :

            a) Village :

            b) Town Panchayat :

            c) Panchayat Union :

            d) Municipal/Corporation :

            e) PWD/Byepass road :

            f) Layout road :

           g) Approved poromboke road :

           h) Private road/path : 

13. Whether there is any approved layout of this department in the surrounding area of the layout site under reference (200M) Yes / No. If yes give details of approval number, DTCP letter no and address of the layout.

14. State whether the following Acts enforced in the local body of the proposed layout site. : Yes / No

    I. Corporation Act :

   II II. Tamilnadu District Municipalities Act 1920 :

   III. Tamilnadu District Municipalities Act 1920 Whether chapter IX and X extended :

  IV. If the site lies in Hill Area, the Tamilnadu District Municipality Act 1920 chapters IX, X, and XA extended.:

  V. Tamilnadu Panchayat Act 1958 :

  VI. G.O.No.44, Planning and Development dated per the G.O. state whether the applicant land lies in the hill area. 

15. The site under reference lies in the D.D.Plan area :

  a) Name of the D.D.Plan :

  b) Stage of the D.D.Plan Consented/ If so give details :

  c) Approved by the Government/ DTCP if so give details :

  d) Land use contemplated in the D.D.Plan :

  e) Confirms to the D.D.Plan provisions :

16. Whether the site under reference have Master Plan, if so, give details : Yes/No.

           a) State of the Master Plan consented/ Approved :

           b) Land use zone by the Master Plan :

           c) Confirms to the land use zone : 

17. Whether the proposed layout has the following activities, if so, give details namely S.F.No. Extend and Address etc :

i) Declared industrial area : Yes/No

ii) Proposal to declare industrial area : Yes/No

iii) Proposal for 4(1) notification : Yes/No

18. Prohibited zone details:- Whether the site under reference lies,

i) In the prohibited area :

ii) In the wet land :

iii) In between 200m. to 500m. coastal area

iv) Heritage area :

v) Garbage site within 90 meters. :

19. Whether the site under reference has any public complaint/litigation, if so, give details:

          i) Applicant’s application with Rs.2/- Court fee Stamp :Yes/No

          ii) Documental evidence for the proposed site : Yes/No

         iii) Approach road details marked in the FMB sketch : Yes/No

         iv) Local body certificate : Yes/No

         v) Tashildar’s original certificate : Yes/No

         vi) If the land lies in the village Panchayat, applications under Rule 3(1) and 3(4) are submitted: Yes/No

        vii) If the land lies in the village Panchayat as per the Tamilnadu Town Panchayat Act 1970,whether the applicant submitted the 9 certificates. : Yes/No

        viii) Whether 5 copies of the proposed layout map annexed: Yes/No

         ix) Topo sketch : Yes/No 

         x) 3 copies of D.D.Plan extract map with signature of TPO/TPI Yes/No

20. If the site lies in the Master Plan area, land use details and Master plan extract map should be annexed; Yes/No

21. If the proposed layout site has any LT/HT electric lines, the applicant’s willingness to realign the line at his cost should be given in the Indemnity Bond of Rs.5/- stamp paper (annexed) : Yes/No 

22. A No Objection Certifiate should be obtained from PWD/ respective authority if the proposed site lies near the water bodies (annexed) : Yes/No

23. If the applicant proposed to construct bridges across the channels at his own cost, permission should be obtained from the appropriate authority, The same may be given by declaration bond of Rs.5/- stamp paper (whether this bond annexed) : Yes/No

24. Whether the certificate of no encumbrance is annexed; Yes/No

25. Whether the recommendation and detailed inspection reports of the TPO/TPI/EO/ Commissioner are annexed; Yes/No    

Place : Commissioner/Executive Officer


Date: Panchayat Union/Town Panchayat.