Form 5 ( See rules 5(2)) APPLICATION FOR PERMISSION TO CONSTRUCT, EXTEND OR TAKE INTO USE ANY BUILDING AS A FACTORY 1) Applicant's name 2) Applicant's profession 3) Applicant's Address 4) Name of the Factory 5) Full Postal address of the factory 6) Situation of the factory a) Town / Village b) Subdivision c) District d) Nearest police station 7) Particulars of the plant to be installed :- 8) Particulars for which Plan-drawing are submitted :- (State whether initial approval/additional installation / additional construction /changes in installation etc) 9) If the plans have been approved earlier give the number and date of approval of previous plans relevant to the present plans except in the case of initial approval. 10) Total installed capacity in Horse Power. 11) Maximum number of workers proposed to be employed in the factory. Signature of the applicant with date & Seal ______________________________________________________________________________ Note: This application should be accompanied by the following documents:- (a) A flow-chart of the manufacturing process supplemented by a brief description of the process in its various stages, list of raw materials used, intermediate products including emission of toxic gases, etc., finished products, by-products, their quantities, methods of storage and handling, loading and transport and details of the arrangements for the disposal of trade waste and effluents, the likely hazards and the methods to control or eliminate them. (b) Plans, in duplicate, drawn to scale, showing - (i) the site of the factory and immediate surroundings including adjacent buildings and other structures, roads, drains etc., and (ii) the plan, elevation and necessary cross-sections of various buildings including all relevant details, relating to natural lighting, ventilation and means of escapes in case of fire. The plans shall also clearly indicate the position of the plant and machinery, aisles and passages; and (iii) such other particulars as the Chief Inspector may require.
