Applicant Address

7at2'
Name:- STP l;"n)/eJ
?t€9+t Address:-
Rrtt^
^t/^ Taluka:- S c, *k
".L
Pin Code:- .$o 31o3
!;'; r;'--.
Telephone No:-
Mobile No:- 9 t e7 7)-h< <r
Email lD:-

To,
The Dy. Director (Fire),
District Fire Station Margao,
Aquem, Margao - Goa

Sub:- Request for lssue / Ftermrct of NOC.

Sir,

I the undersigned, kindly requesting to lssue / Reneltr No Objection Certificate for

my premises for running tt-4,0/,w, I 6rrr(- iness in the
name or SrP l;h;/rJ
the detail of business is filled in the Annexure (enclosed) as per requirement.

Kindly do the needful Please.

Yours faithfully

Enclosed
1) Annexure
2) Owner Ship Document
3) Architectural Plan indicating buildup area signed by owner and
Architect
4) House Tax lTrade Tax Receipt from Municipality / Panchayat.
5) Occupancy Certificate
 ANNEXURE

,t fP / {. PJo},rt o. ff (./r 2,
;'n, ; /e
Name of the Owner with Address & Tel. No. r,u co,l,>re zn /4<, 0t n c,J: n,
"l/.' fu f
1.

Name of the Occupant with address & Tel. S f? Lin, ; kJ, PJo N "'rfC - 4 2
2.
No. Lua to.L!*, LnJ!-Et/-/<- U^,o7'
rt92-9-a+.1 3q6O
3. NOC required in the Name & Style of t TP /io, ,'/.4.
Address of the Business / Trade / Premises to/of po.//e-11 q UlreoJ:nr
4.
with Shop No./ House No. Tnlcul r; a-! G r /-/., tuntoJ:o
5.
Name of the Contact Person & Telephone (avind+o ,4.q!-
No. 9/ 6 7?+t,-o* /o{s,t-2?t3?ot
Any NOC from Panchayat / Municipality / 0 cc*7e-,V An,4./rt-J+ Cc-ut'**7
Health / Certificate of 'Establishment from la
lt&a,
Labour / Tourism Ceftificate / Civil Supplies
Lrcon.'-,,4SPCB
6.
/ Coastal Zone Management Authority W c,'9 (/
I | ,t fleat uz*< C*,ry lty'tazl,
IGSPCB/Certificate / Food and Drugs /
Weight and Measures certificate obtained
t'/

7.
Number of storey and basement for lroua'! * | l/o"+
building.

8.
The Business / Trade / Premises is situated
on which floor. Q r **/ /t-^"t * t
9.
Total Built Up Area of the business 6/7h,79mL
Premises

Whether Fire escape Staircase provided for

10.
building.
Yrs
Number of Entry and Exit provided for the
11.
Business premises /+
12. Whether lift is provided
No
13
Other adjacent occupancies to the business VJ ct 1.,-a 6 x .t<,.r*l- , I un r,'te
premises li/c'b'*l(
I
14 Width of road for Fire Appliance

Boundaries of the business plot

15. lottToe t4o".bouth I a Hf Dc Ro,
North
East 3 o e Dc fo/West ?r;val< Pro p
16. Water Tank Capacity.
3o,oo L*rt .

17. Number of Rooms

18. Total Bed / Table Capacity

19. Number of LPG Cylinder 3 A/oJ.