Schedule – 5
(Related to Sub–rule (1) of the Rule 21)

……………………. Conservation Area
…………………… Conservation Office
License for the Operation of Commercial or Other Activities
1. Name, Surname, Address and Citizenship of the person desiring to take
(receive) a License:–
2. Four boundaries and area of the land for which the license has been
issued :–
3. The purpose of providing the License :–
4. Duration of Validity of the License :–
License issuing officers,–
Signature : ………………………………..
Name, surname : ……………………….
Designation : …………………………….
Date : ……………………………………….