Seal of APPLICATION FORM

Local FOR
Authority BUILDING AND LAND USE PERMIT
(Designed for self-adherence to Guidelines)
FOR
ALL LOCAL AUTHORITIES
REF.No…………/………./……..…
Date of Application: …………………
Effective Date: ……………………….
PART A
About this form Use this form to apply for a Building and Land use Permit for:
(Please tick whichever applies)

RESI – All residential development including enclosure/ wall.

COMM – Commercial development (shops, showrooms, restaurant, etc…).

INDU – Industrial development including hotels, (IRS), workshops, light & general industry.

SERV – Services (offices, banks, etc, community & religious development, educational
institutions)

SE – Commercial development by small enterprise or handicraft enterprise

under the Small Enterprises and Handicraft Development Authority Act 2005.

MORC – Excision of 1 lot or subdivision of land among heirs.

SUI GENERIS – Extractive industry; polluting & noxious industry, builder’s yard, scrap

yard, petrol filling station (as per 11th Schedule of Local Govt Act 2003 as amended).

MOT – Installation of any engine under the Building Act.

CLUSTERS

**Commercial / Industrial / Services / Sui Generis**

In case of an economic activity please state the cluster (as per the 11th schedule of
the Local Govt Act 2003) applicable (Tick as appropriate)**

The BLP Guide 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.
Fees As per Government Notice published by the Relevant Local Authority.

FOR OFFICE USE

Documents submitted (** Please tick as appropriate)
Title Deed/Lease & Planning clearance Approved PER/EIA licence
3 sets of plan Newspapers publications
Location Plan Plate notification certificate
Site Plan CEB clearance
Layout Plans CWA clearance
Elevations General Rate receipt (where applicable)
Sections WWMA Clearance (where applicable)
Structural details Certificate of Registration with SEHDA
Survey Plan for MORC only Application form (Parts A & B) filled in
Power of Attorney/Owner’s consent Neighbour’s consent
Copy of I.D Card Affidavit for Hardship case & MORC
Business Registration Number
1
 Application and Site Details

1. Applicant’s Name Title Mr. Mrs. Miss. Ms.

Address and Contact Surname (or company) …………….…………….

Details First Name…………………………….………….

ID No……………………………………………..
We will post any correspondence Postal address……………………………….….. .
to this address ……………………………………………….…...
…………………………………………….……..
Phone (Office)…………….. (Home)….…………
Fax………………………... (Mobile)...………….
Email……………………………….…………….

2. Location and Location…………………………........................

description of site …………………………………………………..
of proposed Extent……………………………………………
development/ construction TV No. ………………………………………….

3. Applicant’s interest in Is the applicant the owner of the site of proposed development?
the land/ Owner’s YES NO
consent If NO
Name(s) of owner(s) ……………………….……
…………………………………………..…….…
Signature of owner(s)……………………………
ID No. ………………………Date………...……

If you are signing on the owner’s behalf as their legal representative,

please state your legal authority under and attach documentary
evidence (e.g. Power of Attorney, written consent)
…………………………………………………..........

4. Description of …………………………………………..…………………
proposed development …………………………………………………………….
…………………………………………………………….
…………………………………………………………….
…………………………………………………………….

(Specify the no. of floors & no. of res/comm. units & type of commercial/industrial activity)

5. (a)Present use of Use……………………………………………………………….

the site (applicable Hours of operation……………………………………………….
for an economic No. of employees…………………………………………………
activity) Ref. No. of relevant permit previously obtained…………………
Date of cessation.…………………………………………………

2
 (b)Details on Hours of operation………………………………………………
Proposed economic No. of employees………………………………………………..
activity Plant/ Machinery to be installed…………………………………
Type and quantity of goods to be produced / stored…………….
………………………………………………………………......
No. of vehicles expected………………………………………..

6. Does your proposal Any scheduled activity under the Environment Protection Act
involve any of for which an approved Preliminary Environmental Report or an
the following? Environment Impact Assessment licence is required?

A land conversion permit from the Ministry of Agro- Industry.

Notification procedures.

7. Your declaration 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
If applicant is a company also understand that
or association, the form
must be signed by a (a) an effective date will be given to my application immediately
director or authorized if all plans and documents specified in the technical checklist
person under accompanying this form have been submitted.
common seal.
(b) if incomplete the application will not be accepted nor registered.

Signature:……………………………………… Date:………………...

8. Declaration by applicant I / we hereby declare that the following agents/companies have

relating to service prepared the plans submitted by me/us.
providers,
e.g. / Architect/ Name of Architect/Town Planner _____________________
Town Planner/ draughtsman/Land Surveyor: _____________________
Draughtsman/ Engineer: _____________________
Sworn Land Surveyor
and Engineer Vat registration no. if applicable: …………………..

Signature: ……………………………….

Office Use:
Receiving Officer: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________________
Name Signature

Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _