FORM - A
Form for seeking prior approval of Central Government under section 2 of the Forest(Conservation) Act,1980 for Diversion of fresh forest area
PART - I
(To be filled up by User Agency)
A. General Details
A-1. Project Details
  (i). Proposal No. : FP/KA/ROAD/33150/2018   (ii). Name of Project for which Forest Land is required : NH-66 Four laning between Goa-Karnataka Border to Kundapur   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 2.469 ha of forest land in Sy.No.10/A1 of Hattikere Village, Ankola Taluk U.K District, Karwar Division for construction Toll plaza with amenities for Up gradation of NH 66 between Goa-Karnataka Border and Kundapur-.   (iv). State : Karnataka   (v). Category of the Proposal : Road   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 168000   (viii). Area of forest land proposed for diversion(in ha.): 2.469   (ix). Non-forest land required for this project(in ha.): 3.16   (x). Total period for which the forest land is proposed to be diverted(in years): 100
A-2. Details of User Agency
  (i). Name : NATIONAL HIGHWAYS AUTHORITY OF INDIA REGIONAL OFFICE BENGALURU   (ii). Address1 : National Highways Authority of India, Project Implementing Unit, Door No.3-29, "Bethel", Tharethota, Near Pumpwell (NH-66), Mangalore   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Bangalore Urban   (vi). Pin : 575005   (vii). Landmark : Nantoor Circle NH-13   (viii). Email address : acharya_1951@yahoo.com   (ix). Landline Telephone No. : 824-4264499   (x). Fax No. : 824-4254499   (xi). Mobile No. : 9686289595   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Central Government
A-3. Details of Person Making Application
  (i). First Name: Naveen   (ii). Middle Name: J   (iii). Last Name: S   (iv). Gender: Male   (v). Designation: Site Engineer   (vi). Address 1: C/o National Highways Authority of India, Project Implementing Unit, Mangalore   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Dakshina Kannada   (x). Tehsil: NIL   (xi). Pin: 575002   (xii). Landmark: Near Pumpwell NH-66   (xiii). Email Address: jsnaveen728@gmail.com   (xiv). Landline Telephone No.: 8254-253637   (xv). Fax No.: 00   (xvi). Mobile No.: 7259924698   (xvii). Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency:
B. Details of land required for the Project
B-1. Details of proposal seeking prior approval of Central Government under the Act for diversion of forest land for the Project already submitted in the past
List of proposal submitted in Past
S.no Proposal Status. Proposal No. Moef File No. Area Proposed for Diversion(Ha.) Area Diverted(Ha.) Date of In-Principle Approval Date of Final Approval
NIL
B-2. Details of forest land proposed to be diverted
B-2.1 Details of Divisions involved
Details of Divisions involved
S.no Division Name Forest Land(ha.) Non-Forest Land(ha.)
1.Karwar2.4693.16
Total2.4693.16
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Uttara Kannada2.4693.16
Total2.4693.16
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Hattikeri village non forest03.16
2Hattikeri village Sy No 10A1A1A2.4690
Total 2.469 3.16
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Toll Booth0.010
2BC Road00.147
3Open Space1.221.931
4PQC Road1.14030.846
5Weigh Bridge00.236
6medical aid0.01860
7Admin Building0.08010
Total 2.469 3.16
C. Maps of forest land proposed to be diverted
Division 1. : Karwar
  (i). Area of forest land proposed to be diverted(in ha.) : 2.469   (ii). Nature of the Project: Non Linear   (a). No. of patches : One
Patch wise details
Patch No. Area of Patch(in ha.) Kml File of PatchesTo view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.2.469    View File
  (iii). Copy of Survey of India Toposheet indicating boundary of forest land proposed to be diverted:   (iv). Scanned copy of the Geo-referenced map of the forest land proposed to be diverted prepared by using GPS or Total Station:
D. Justification for locating the Project in forest land and details of alternatives examined:
  (i). Copy of note containing justification for locating the Project in forest land:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 60   (iii). Temporary Employment(Number of person-days): 200
F. Displacement of People due to the Project, if any
  (i). Whether Project involves displacement?: No
G. Details of Cost-Benefit analysis for the Project
  (i). Whether the Project requires Cost-Benefit analysis?: No
H. Status of Environmental Clearance
  (i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? : No
I. Status of Wildelife Clearance
  (i). Whether the Project or a part thereof is located in any Protected Area or their Eco sensitive zone? : No
J. Applicability of special provisions governing Scheduled Areas
  (i).Whether the Project or a part thereof is located in a Scheduled Area? : No
K. Status of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted
  (i). Whether the process for settlement of Rights under the Forest Rights Acts 2006 on the forest land proposed to be diverted has been completed? : No
L. Details of land identified for Compensatory Afforestation
  (i). Whether non-forest or Revenue forest land is required to be provided by User Agency?: Not Applicable   (ii). Whether the area of non-forest land or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation is less than area of forest land proposed to be diverted ?: Not Applicable   (iii) . Reason for not providing Non-Forest Land: Not Applicable
Additional information Details
Documents
S.No Documents
Remarks
1Non availability Certificate from DC, U.K District
2Detailed Project Report
3Clarification Note Regarding Work done
4GPS Readings of Forest and Non Forest Land
5Details of Non Forest Land reqired for toll plaza
6Reply to EDS Raised by DCF/APCCF(fc)
7Layout Plan
8Toll plaza layout imposed on geo reference map
9Undertaking for NPV and CA
10Competent Authority Map Showing hissas in Hattikeri in Sy No 10
11Note regarding Proposed Area
12Reason For constructing Toll plaza
13Consent Letter From Naval Authorities for re diversion