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/TRANS/30483/2017   (ii). Name of Project for which Forest Land is required : Construction/Erection of Express feeder line(Transmission line) having 11kv capacity from Teradal Sub station to Proposed Jackwell of Tamadaddi Village Through Teradal Forest Area for providing Drinking water Supply to Palbhavi and Other Four Villages in Raibag Taluk.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Construction/Erection of Express feeder line(Transmission line)having 11kv capacity from Teradal Sub station to Proposed Jackwell of Tamadaddi Village Through Teradal Forest Area for providing Drinking water Supply to Palbhavi and Other Four Villages in Raibag Taluk.   (iv). State : Karnataka   (v). Category of the Proposal : Transmission Line   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 1900   (viii). Area of forest land proposed for diversion(in ha.): 0.91   (ix). Non-forest land required for this project(in ha.): 5.012   (x). Total period for which the forest land is proposed to be diverted(in years): 30
A-2. Details of User Agency
  (i). Name : RUREL DRINKING WATER SUPPLY AND SANITATION SUB-DIVISION RAIBAG   (ii). Address1 : Assistant Executive Engineer   (iii). Address2 : R.D.W.S and S Sub-Division Raybag.   (iv). State : Karnataka   (v). District : Belgaum   (vi). Pin : 591317   (vii). Landmark : opp KVG Bank   (viii). Email address : rwsraibag@gmail.com   (ix). Landline Telephone No. : 8331-225296   (x). Fax No. : 8331-   (xi). Mobile No. : 9449624872   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Padmaja   (ii). Middle Name: D   (iii). Last Name: Patil   (iv). Gender: Female   (v). Designation: AEE   (vi). Address 1: Assistant Executive Engineer   (vii). Address 2: R.D.W.S and S Sub-Division Raybag.   (viii). State: Karnataka   (ix). District: Belgaum   (x). Tehsil: Raybag   (xi). Pin: 591317   (xii). Landmark: At Opposite KVG Bank   (xiii). Email Address: rwsraibag@gmail.com   (xiv). Landline Telephone No.: 8331-225296   (xv). Fax No.: NIL   (xvi). Mobile No.: 9901959110   (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.Bagalkot0.915.012
Total0.915.012
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Bagalkot0.915.012
Total0.915.012
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Teradal Survey No, 5520.910
2Teradal Survey No, 56500.147
3Teradal Survey No, 54600.245
4Teradal Survey No, 52300.245
5Teradal Survey No, 52400.07
6Teradal Survey No, 523/100.14
7Teradal Survey No, 50500.07
8Teradal Survey No, 50400.245
9Teradal Survey No, 50300.07
10Teradal Survey No, 50200.105
11Teradal Survey No, 50100.35
12Teradal Survey No, 50000.14
13Teradal VR Survey No, 49900.07
14Teradal Survey No, 49800.07
15Teradal Survey No, 49700.14
16Teradal Survey No, 49400.07
17Teradal Survey No, 49300.07
18Teradal Survey No, 49000.07
19Teradal Survey No, 48900.07
20Teradal Survey No, 48300.28
21Teradal Survey No, 48200.07
22Teradal Survey No, 48100.07
23Teradal Survey No, 47900.14
24Teradal Survey No, 47800.14
25Teradal Survey No, 47700.07
26Teradal Survey No, 47600.07
27Teradal Survey No, 47500.21
28Tamadaddi Survey No, 6600.42
29Tamadaddi Survey No, 6900.07
30Tamadaddi Survey No, 9000.14
31Tamadaddi Survey No, 9200.07
32Tamadaddi Survey No, 9100.21
33Tamadaddi Survey No,500.175
34Tamadaddi Survey No,300.14
35Tamadaddi Survey No,200.07
36Tamadaddi Survey No,100.21
Total 0.91 4.942
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Transmission Line0.915.012
Total 0.91 5.012
C. Maps of forest land proposed to be diverted
Division 1. : Bagalkot
  (i). Area of forest land proposed to be diverted(in ha.) : 0.91   (ii). Nature of the Project: Linear   (b). No. of Segments : One
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).
1.0.91    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: After verification no Alternative land is availabl
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?: No
H. Status of Environmental Clearance
  (i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? : Yes   (a). Status of the Environmental Clearance to the Project: EC application yet to be submitted
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
1Under Taking letter for Transmission line
2This Project Administration Approved copy
3Transmission line(KEB) administration approved copy
4Geo Referenced Map
5Toposheet Map
6AUTO CAD Drawing of Transmission line of Teradal village
7AUTO CAD Drawing of Transmission line of Teradal village Alignment of A
8AUTO CAD Drawing of Transmission line of Teradal village Alignment of B
9To provide Cadastral map in Large Scale of Teradal village
10Teradal Village Cadastral map
11Tamadaddi Village Cadastral map