Seal of

Local
Authority

APPLICATION FORM

BUILDING & LAND USE PERMIT

(Designed for self-adherence to Guidelines)

ALL LOCAL AUTHORITIES

REF. No. RESI /./.

Date of Application:
Effective Date: .

Form No. :
BLP 1

About this form

The BLP Guide

Fees

Use this form to apply for a Building and Land Use Permit for a residential
development not exceeding Ground floor + 3 levels.

This form consists of 3 parts:

Part A: Application and Site Details (to be filled in by applicant)
Part B: Technical Checklist ( to be filled in by Draughtsman / Professional)
Part C: Schedule of fees( to be filled in by Draughtsman / Professional)

The BLP Guide tells you how to fill in this form and about the plans and other
documents that you must provide with this application. Ask us for a copy and read
it before filling in the application form.

As per Government Notice published by the Relevant Local Authority. Refer to Part C
FOR OFFICE USE

Documents submitted (** Please tick as appropriate)

Title Deed / Lease & Planning clearance

CEB clearance

Location Plan

General Rate receipt (where applicable)

3 sets of plan

CWA clearance

Site Plan

WMA Clearance (where applicable)

Elevations

Neighbours consent

Layout Plans
Sections

Structural details

Power of Attorney / Owners consent

Application form (Parts A,B &C) filled in

Affidavit for Hardship case
Copy of I.D Card

PART A :
1.

APPLICATION AND SITE DETAILS

Applicants Name
Address and Contact
Details

We will post any

correspondence to this
address

Title

Mr.

Mrs.

Miss.

Ms.

Surname (or company) ....................................................................................

First Name............................................................................................................
ID No .....................................................................................................................

Postal address .....................................................................................................

..................................................................................................................................

..................................................................................................................................

Phone (Office) ......................................... (Home) ..........................................

Fax ......................................... (Mobile) .........................................
Email .................................................................................................

2.

3.

Location and
description of site of
proposed development /
construction
Applicants interest in
the land/ Owners
consent

Location ................................................................................................................

..................................................................................................................................

Extent ....................................................................................................................

TV No. ..................................................................................................................
Is the applicant the owner of the site of proposed development?

YES

If NO

NO

Name(s) of owner(s) .........................................................................................

..................................................................................................................................

Signature of owner(s) .......................................................................................

ID No....................................................

Date ........................................

If you are signing on the owners behalf as their legal representative,

please state your legal authority under and attach documentary
evidence (e.g. Power of Attorney, written consent) Attach separate
sheet if space is insufficient.
..................................................................................................................................

4.

Description of
proposed development

..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................

5.

Present use of the site

Use .........................................................................................................................

6.

Does your proposal

involve any of
the following?

Any scheduled activity under the Environment Protection Act

for which an approved Preliminary Environmental Report or an
Environment Impact Assessment licence is required?
A land conversion permit from the Ministry of Agro - Industry.

Notification procedures.
7.

Your declaration

If applicant is a company
or association, the form
must be signed by a
director or authorized
person undercommon seal.

I apply for consent to carry out the development described in this

application. I declare that all the information given is true and correct.
I undertake not to influence in any manner whatsoever the processing
of my application for a permit. I also understand that :
(a) an effective date will be given to my application immediately if
all plans and documents specified in the technical checklist
accompanying this form have been submitted.

(b) if incomplete the application will not be accepted nor registered.

Signature :.................................................... Date :..................................
8.

Declaration by applicant
relating to service
providers, e.g. / Architect /
Town Planner /
Draughtsman /
Sworn Land Surveyor
and Engineer

I / we hereby declare that the following agents/companies have

prepared the plans submitted by me/us.
Name of Architect/Town Planner/

_____________________

Engineer:

_____________________

Draughtsman/Land Surveyor/

_____________________

Vat registration no. if applicable : ...................................................

Signature of applicant ..........................................................................
OFFICE USE
Receiving Officer :..........................................................................
Name
Date :..................................

..........................................................................

Signature

PART B :
1.0

BUILDING AND LAND USE PERMIT APPLICATION

TECHNICAL CHECKLIST

(i)
(ii)
(iii)

(iv)
(v)
(vi)
(vii)
(viii)
(ix)

(x)

To be filled

To be filled in for all applications

3 sets of plans preferably on A4 or A3 size drawn to metric scale

and signed by Professional/s submitted :

Location plan showing distances from specific and prominent

landmarks preferably to the scale 1:2500, as well as width and status
of access roads.

Site plan showing plot dimensions, layout of building with set backs
from all boundaries, access roads & HWM, parking layout, septic
tank/other waste disposal system and any other existing structures
preferably to the scale of 1:200

Area of site, area of each floor and detailed calculations for plot
coverage and parking shown on site plan
(a)

(b)

Any basement proposed

Contour plan submitted to justify the basement level

Layout plans of each floor preferably to the scale of 1:100 or 1:200

showing clearly proposed use of all rooms.

Main elevations preferably to the scale of 1:100 or 1:200, showing

height of building

Cross-sections preferably to the scale of 1:100 or 1:200 showing

height of building

Title deed submitted

Structural details submitted include:

Foundation layout

Columns/Foundation details (bases, strip footing, etc.)O

Beam details for each level

in if your

Slab/s details for each level

involves

Basement (if any)

development
building

construction

(xi)

(xii)

(xiii)
(xiv)

Stairs

Septic Tank/other waste water disposal system

Copy of all structural details of existing structure (if applicable)

C.E.B Clearance (for all construction)

C.W.A / W.M.A Clearance (for new construction)

Engineers certificate in case of building over 2 levels or span

exceeding 5 m

Consent and copy of identity card of neighbour for construction at

less than 0.9m from the common boundary

* Please put a  in the YES/NO box or a
if it is not applicable to your application.

Applicant Use
YES
NO

Office Use
YES
NO

(xv)
(xvi)
(xvii)
(xviii)
(xix)

2.0

1.
2.

Lease/letter of reservation and planning clearance in case of state

land

PER/EIA licence submitted for scheduled undertakings as per

Environment Protection Act

Land Conversion Permit /Declaration form for exemption under SIE

Act for ownership of 1 Ha in aggregate

Clearance from Ministry of Agro-Industry (Forestry Division)

submitted for construction within river reserves (if applicable)
Details of all walls & fences shown on plans

FOR ALL TYPES OF DEVELOPMENT (except MORC & MOT applications)

(Compliance with Outline Scheme, PPG & Building Regulations)

Site is located within or on edge of settlement boundary or within growth

zone or within limits of permitted development, coastal frontage , coastal
land , inland. **
Complies with policies of the Outline Scheme

(i)

Site is outside settlement boundary / growth zone / limits of

permitted development **

(ii) Affidavit submitted to prove hardship as per policy of Outline

Scheme
(i)

Site is an agricultural land, as per definition in SIE Act.

(ii) Land conversion permit has been obtained from the Ministry of
Agro-Industry

(iii) Declaration submitted for exemption from land conversion as per

S.I.E (Amendment) Act 2005
(iv) Clearance from Water Resources Unit Borehole

(v)
5

6
7

Clearance from Irrigation Authority for site located in Irrigation

Zones

Formal commitments given by Ministry responsible for Public Utilities,

the Town and Country Planning Board, the Ministry of Housing and
Lands or under a Government approved scheme prior to the approval of
the Outline Scheme. Bona fide evidence submitted
Clearance from Ramsar Committee if site on wetland

Proposal can be readily connected to existing transport and utility

networks or can be connected without unacceptable public expense

* Please put a  in the YES/NO box or a
if it is not applicable to your application.

Applicant Use
YES
NO

Office Use
YES
NO

Applicant Use
YES
NO

8 Building Set Backs

(a)

From roads
(i)

(ii)

15 m from motorway

6 m from A or B road

(iii) 4.5 m from any other road

(iv) 3 m from lightly-trafficked road

(b)

(v)

1.5 m from minor access roads

(i)

0.9 m from side and rear boundaries (other than coastal zone)

From side and rear boundaries

(ii)

At less than 0.9 m or on common boundary

(iii) Neighbours consent submitted for (ii) above

(iv) A distance of 1.8 m observed between 2 buildings

(c)

The following setback provided for building 7.5m or above in

height:Building height (m)

Mins. set back (m)

15.0

3.0 side
3.0 15.0 front

7.5

25.0
9

2.0 side
3.0 - 15.0 front

5.0 side
6.0 15.0 front

(i) The following set backs have been observed from:

River-16m / Rivulet-8m / Feeder-3m **

(ii) Permission obtained from the Ministry of Agro-Industry for building

within river reserve

10 Guidelines applicable to coastal zone

(i)

20% plot coverage within coastal frontage A

(ii) 27.5% plot coverage within coastal frontage B

(iii) 30% plot coverage within coastal road C

(iv) 40% plot coverage within coastal road D & inland

(v) Height:
G +1 for Coastal Frontage A (13m max)
G+1+33% of G for Coastal Frontage B (13m max)
G+1+50% of G within Coastal Road C (13m max)
G+2 within Coastal Road D (15m max)
G+2+50% of G within Inland (18m max)

* Please put a  in the YES/NO box or a
if it is not applicable to your application.

Office Use
YES
NO

(vi)

3 m from side and rear boundaries in coastal frontage A & B

Applicant Use
YES
NO

Office Use
YES
NO

(vii) 2 m from side and rear boundaries within coastal road C & D and
inland E

(viii) Septic tank/other waste water disposal system at 2m from boundary

and 2m from building

(ix)

(x)

Building located at 30m from high water mark (HWM)

Provisions have been made for accessibility for persons with

disabilities

Signature of Service Provider : ..........................................................................................

Date ..........................................

* Please put a  in the YES/NO box or a
if it is not applicable to your application.

.......................................

Signature of Officer

.......................................

Date

PART C SCHEDULE OF FEES PAYABLE ON ISSUE OF PERMIT

Tick as appropriate

1. Change of use from one cluster to another

Fees Payable

Rs 1000

2. Change of use within same cluster

(Where a BLP is required)

Rs 1000

3. Construction of building or part of building, including extension to / or

conversion of existing building
(a)

(b)
(c)

of a floor area of not more than 250m

Rs 10/m (subject to a minimum of Rs500)
Total Floor Area :................................ m

of a floor area of more than 250m but not more than 500m Rs20/m
Total Floor area :................................ m

of a floor area of more than 500m Rs50/m

Total Floor Area :................................ m

Rs 500

5. Engineering or other operations in, on, over and the land

(including rock quarry, golf course, marina)

Rs 5,000

6. Excision/Subdivision of land among heirs- Rs500/lot

Number of lots :................................

7. Extensive alterations, additions or repairs to an existing building

I hereby certify that the above is correct

Signature of Service Provider

Rs...........
Rs...........

4. Development by small enterprise registered with SEHDA

Total Floor Area :................................ m

.........................................................................................

Rs...........

Rs...........

Rs 1,000

................................

Date

FOR OFFICE USE ONLY

Calculation of fees: Correct / Incorrect

Discrepancies :..............................................................................................................................................................................

....................................................................................................................................................................Actual fees

.........................................................................................

Name & Signature of Officer

................................

Date

payable: