After Form A of the said rules, the following new forms shall be inserted, namely:- "FORM- A1 [see rule 3(1)] Declaration From, …………………………….
…………………………….
…………………………….
To, The chairman, District stone Crusher licensing and regulation authority …………………….District.
Sir/madam, I/we hereby declare that the stone crusher established in the name of M/s…………………………………………….locatedin Sy.no…………of ……………………village, …….………….taluk, ………………….district over an extent of …………….acre is in existence since………………..and on the basis of the documents produced herewith;
I certify that conditions stipulated in the Act for declaring the safer zone is complied and I request that safer zone be declared and a certificate is issued to me in this regard;
or 5 I certify that conditions stipulated in the Act for declaring the safer zone is not satisfactorily complied by the place/land of existing stone crusher mentioned above and therefore I propose the land at Sy.no………………….of …………………..village, ……………………taluk, …………………..district over an extent of …………..acre may be considered for the purpose of declaring the safer zone and issue a certificate in this regard.
.*strike out, whichever is not applicable.
The details are as follows;
Sl.
no Particulars Prescribed Existing
1. The distance from the nearest National Highway 200 meters
2. The distance from the nearest State Highway 200 meters
3. The distance from the nearest major district road or other roads 100 meters
4. The distance from the nearest
(i) revenue village
(ii) temple
(iii) school 500 meters 500 meters 500 meters
4. Whether located outside the limits of Municipal corporation, city municipal corporation, town municipal council, as the case may be Yes
5. Details of license issued by any other authorities prior to commencement of Act. (enclosecopiesif any)
6. Extent of land available for establishing stone crusher Minimum 1 acre
7. Reasons for non-compliance of the conditions stipulated in the Act/any other documents enclosed in support of compliance of conditions stipulated in the Act.
8. Remarks/any other information Mandatory Enclosures;
(1) Revenue or land sketch of the existing crusher/proposed area showing material details.
(2) RTC or property extract of the existing/proposed land.
(3) License/consent copy of any authorities issued for stone crusher before the commencement of the Act.
(4) Consent of land owner if any.
Date:
Place:
Signature of the applicant.
6 "FORM- A2 [see rule 3A] Register of application for license Sl.
No N am e o f th e ap p li ca n t an d a d d re ss Details of location applied for establishing stone crusher.
D at e o f ap p li ca ti o n re ce iv ed W h et h er e x is ti n g / n ew st o n e cr u sh er D at e o f C er ti fi ca te o f co m p li an ce i ss u ed a n d it s n u m b er L ic en se n u m b er a n d d at e o f is su e D is tr ic t T al u k V il la ge S y .N o E x te n t la n d t y p e