Special Permit Application

(In Termsof Section 14(3) of Coast Conservation & Coastal Resource Management Act No. 57 of 1981)

Applicant Name*

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NIC*

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Address*

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Telephone

Telephone number not valid

Mobile*

Mobile number not valid

Email*

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Fax

Location of the Land Clearance (Address)*

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Province*

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District*

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District Secretariat Office*

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Local Authority*

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GN Office *

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No of the Survey Plan*

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Lot No*

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Extent of the Land*

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Name of the Surveyor*

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Ownership of the Land

Applicant*

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Address*

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Purpose of Land Clearance

Purchasing the Land

Rent Out/ Lease

Any Other Details

Payment Method*

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