SIMPLIFIED APPLICATION FOR OBTAINING CLEARANCE FROM POLLUTION ANGLE FROM MEGHALAYA STATE POLLUTION CONTROL BOARD, SHILLONG (APPLICABLE TO COTTAGE INDUSTRIES ONLY) Note: Any applicant knowingly giving incorrect information or by-passing any information pertaining thereto shall be liable to be punished under the Water (Prevention & Control of Pollution) Act, 1981, and Environment (Protection) Act, 1986 and Rules made there under. 1. Name of Industry : ........................ ........................ ........................ 2. Location : ........................ ........................ ........................ 3. Address for correspondence : ........................ ........................ 4. (a) Names of products and daily capacity. : ........................ (b) Names of raw materials and daily : ........................ consumption. 5. Brief description of manufacturing : ........................ process (Attach separate sheet, if required) 6. Whether any water is required for : ...................... industrial purpose. 7. (a) Whether any fuel is required for : ........................ industrial purpose. (b) If yes, give name/names : ........................ of requirement. 8. Whether the industry is likely to give : ....................... rise to any pollution/nuisance due to:- ..p/2 (a) Whether pollution/industrial effluent : Yes/No (b) Air pollution: (i) Suspended Particulate Matter : Yes/No or Dust (ii)Chemical vapours or gases : Yes/No (iii) Noise : Yes/No (iv) Smell/Odour : Yes/No (c) Solid wastes arising, if any : Yes/No 9. The arrangement proposed to be provided : ....................... for domestic waste water/air pollution/ solid waste disposal. ........................ 10. Whether permission has been taken : ....................... from local authorities (Municipalities or Village Dorbars, etc) ........................ 11. Whether the site of the unit is : ........................ approved for location by competent authorities, such as Industries Deptt., ......................... Town planning Deptt., etc. 12. Undertaking:- 1. The information given is true to the best of my knowledge. 2. If our Industry is found to be causing any type of pollution/nuisance by the Officers of the Meghalaya State Pollution Control Board, I/We undertake to obtain consent as required under the Acts and comply with the conditions stipulated by the Meghalaya State Pollution Control Board within the time period prescribed by it. (Signature of the Applicant) Name ...................... Address ...................... ...................... ...................... Phone No..................... Text Box: 2
