FORM H (See Rule 68) Application for the quarrying permit From: Tel No. Date: To, The Director, Directorate of Mines, Udyog Bhavan, Panaji Goa. Sir, 1) I/We submit an application for a quarrying permit for .( Mineral ) from the area described below: 2) A sum of Rs. ..... towards application fees for the permit has been paid in the Government Treasury at .......and the receipted challan is enclosed. 3) The required particulars are given below: (i) Name of the applicant: ____________________ (ii)Profession of the applicant :________________ (iii)Address of the applicant : _________________ (iv)Quantity proposed to be removed under the permit: ______m3 (v)Details of the area from which the minerals are to be removed : (a) Village/Forest Range: ______________ (b)Survey No : _________ (c) Area in Sq mts.____________ (vi) Period of validity of the quarrying permit.______________ I/We declare that the above particulars are correct and request that a quarrying permit may kindly be granted. Yours faithfully, (Signature of the Applicant) Enclosures: (1) A copy of cadastral survey plan showing the location of the area proposed for quarrying permit. (2) Record of Rights in Form I and XIV or Index of Lands in Form III as the case may be. (3) An affidavit that the applicant has obtained the consent of the occupant for the purpose of quarrying.
