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/RJ/WATER/14787/2015   (ii). Name of Project for which Forest Land is required : Teodi Road Virat Nagar W.S.S. Ganesh Temple Area   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : W.S.S. Ganesh Temple Area,Virat Nagar   (iv). State : Rajasthan   (v). Category of the Proposal : Drinking Water   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 20   (viii). Area of forest land proposed for diversion(in ha.): 0.25   (ix). Non-forest land required for this project(in ha.): 0.73715   (x). Total period for which the forest land is proposed to be diverted(in years): 50
A-2. Details of User Agency
  (i). Name : PUBLIC HEALTH ENGINEERING DEPARTMENT   (ii). Address1 : "Jal Bhawan", 2-Civil Lines,   (iii). Address2 : Jaipur   (iv). State : Rajasthan   (v). District : Jaipur   (vi). Pin : 302006   (vii). Landmark : Near railway Station   (viii). Email address : aephedvrt@gmail.com   (ix). Landline Telephone No. : 141-2222337   (x). Fax No. : 141-   (xi). Mobile No. : 9610016008   (xii). Website (if any) : www.rajwater.gov.in   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Manohar   (ii). Middle Name: Lal   (iii). Last Name: Jangid   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: Village-Jajain Kalan, Tehsil-Shahpura, District-Jaipur   (vii). Address 2: NIL   (viii). State: Rajasthan   (ix). District: Jaipur   (x). Tehsil: Shahpura   (xi). Pin: 303103   (xii). Landmark: NIL   (xiii). Email Address: aephedvrt@gmail.com   (xiv). Landline Telephone No.: 141-2222337   (xv). Fax No.: NIL   (xvi). Mobile No.: 9610016008   (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.Jaipur (North) Territorial0.250.73715
Total0.250.73715
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Jaipur0.250.73715
Total0.250.73715
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Virat Nagar0.250.73715
Total 0.25 0.73715
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1TUBE WELL0.00640
211 kv Electric Line0.2271290.679
3Laying Pipe line 100 mm Dia0.016450.0581495
Total 0.249979 0.7371495
C. Maps of forest land proposed to be diverted
Division 1. : Jaipur (North) Territorial
  (i). Area of forest land proposed to be diverted(in ha.) : 0.25   (ii). Nature of the Project: Linear   (b). No. of Segments : Three
Segment wise details
Segments Segment Area(in ha.) Kml File of Segments
(To view KML file on google the same may be downloaded and then open if in google earth install in your computer).
1.0.0064    View File
2.0.01645    View File
3.0.227129    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:   (ii). Whether a copy of map indicating location of alternative examine is required to be provided: No   (a). Reason for not providing such map: Ground Water is not available in near surrounded a
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: No
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?: Yes   (a). Copy of Cost-Benefit analysis:
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? : Yes   (a). Copy of documentry evidence in support of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted:
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
1Administrative and Financail Sanction
2AUTHORIZATION LETTER
3BAR CHART
4CERTIFICATE FOR MINIMUM USE OF FOREST LAND
5JUSTIFICATION FOR LOCATING THE PROJECT IN FOREST AREA
6STATEMENT OF FOREST AND NON FOREST LAND
7UNDERTAKING FOR CONSERVATION OF FLORA-FAUNA AND WILDLIFE ANIMALS DURING LAYING PIPE LINE
8UNDERTAKING FOR MINIMUM USE OF FOREST LAND
9UNDERTAKING FOR MUCK DISPOSAL DURING LAYING PIPE LINE ACTIVITY
10UNDERTAKING FOR NO CHANGES IN STATUTORY POSITION OF DIVERTED FOREST LAND
11UNDERTAKING FOR PAYMENT OF COST OF COMPENSATORY AFFORESTATION
12UNDERTAKING FOR PAYMENT OF NET PRESENT VALUE OF FOREST AREA
13UNDERTAKING FOR USE OF ANY MATERIAL FROM SURROUNDED FOREST LAND DURING DURING LAYING PIPE LINE
14MAP SHOWING FOR GEO-REFERENCED SURVEY OF INDIA TOPO SHEET WITH FOREST BOUNDARY AND PROPOSED LAYING PIPE LINE , TUBE WELL AND 11 KV ELECTRIC LINE
15DIGITAL MAP SHOWING FOR REQUIRED FOREST LAND COORDINATES AND PROPOSED LAYING PIPE LINE , TUBE WELL AND 11 KV ELECTRIC LINE
16GOOGLE MAP SHOWING FOR REQUIRED FOREST LAND COORDINATES AND PROPOSED LAYING PIPE LINE , TUBE WELL AND 11 KV ELECTRIC LINE
17Grampanchayat NOC
18Nagar Palika NOC
19Revenue Officer Report
20Tahsildar Sahab Report.
21Hydrogeologist Report.
22Requirement Certificate.
23KHASRA MAP SHOWING FOR REQUIRED FOREST LAND COORDINATES AND PROPOSED LAYING PIPE LINE , TUBE WELL AND 11 KV ELECTRIC LINE
24EDS reply 21.07.2018
25Forest land & Non forest land area details
26Hydrogeologist report justification 002
27Layout Plan & Map of project 003
28Revised Bar Chart 005
29Under Taking of user agency 006
30Hydrogeologist Report
31Required Information letter
32Undertaking
33Layout Plan (Map)of Project
34Electric Bill
35Forest Department Inspection Report.
36Undertaking for CA and NPV.
37Jamabandi Nakal.
38Cadastral Map.