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SITE IDENTIFICATION
Site Candidate
Site ID
(A/B/C etc.)
Name of Site Candidate
Site Address
Kelurahan
Kecamatan
Kabupaten / Kotamadya
Post Code
City/Province
Visit date
Nominal Longitude
Nominal Latitude ASL :
M
Search Radius Meters
GPS Surveyed Longitude (WGS
84)
GPS Surveyed Latitude (WGS
84)
Address
Kelurahan
Kec.
Kab.
Prop.
Telephone No./HP./Fax
Person responsible for access to the site
Address
Kelurahan
Kec.
Kab.
Pro
Telephone No./HP./Fax Hp
Single owner Corporation Other
Type of Ownership: Master Agreement Site Community
Government Partnership
10 hours
Access Time for Work
Length x
Land / Rooftop Area x Area (m2)
Width (m)
Length x
Private Access x
Width (m)
Lease 10 Years Can be Yes
Acquisition Type (min)
Buy extended No
Girik/Persil No.
Land Ownership
Certificate No.
documents
SPPT/PBB No.
Others
Permits Required
RT/RW Tata Kota (RUTR) IMB
Comments