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/Approach/146453/2021
(ii). Name of Project for which Forest Land is required :
Construction of Approach Access for Proposed Hindustan Petroleum Corporation Retail Outlet on Barmer- Sanchor Road NH-68 (RHS) on Khasra No-2684/2195 & 3147/2195 (Patta No F-8/90A/2013/15164) Chainage 157/766 to157/786, At Village – Barmer Gadan Tehsil & District – Barmer(Rajasthan)
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
Construction of Approach Access for Proposed Hindustan Petroleum Corporation Retail Outlet on Barmer- Sanchor Road NH-68 (RHS) on Khasra No-2684/2195 & 3147/2195 (Patta No F-8/90A/2013/15164) Chainage 157/766 to157/786, At Village – Barmer Gadan Tehsil & District – Barmer(Rajasthan)
(iv). State :
Rajasthan
(v). Category of the Proposal :
Approach Access
(vi). Shape of forest land proposed to be diverted :
Linear
(vii). Estimated cost of the Project(Rupees in lacs) :
45
(viii). Area of forest land proposed for diversion(in ha.):
0.0435
(ix). Non-forest land required for this project(in ha.):
0.0655
(x). Total period for which the forest land is proposed to be diverted(in years):
19.90
A-2.
Details of User Agency
(i). Name :
Hindustan Petroleum Corporation Limited
(ii). Address1 :
HINDUSTAN PETROLEUM CORPORATION LIMITED , Jodhpur Retail Region, Bhagat ki Kothi Diesel shed Road,Jodhpur
(iii). Address2 :
NIL
(iv). State :
Rajasthan
(v). District :
Jodhpur
(vi). Pin :
342005
(vii). Landmark :
Bhagat ki Kothi
(viii). Email address :
gautamchanddoshi@gmail.com
(ix). Landline Telephone No. :
0-
(x). Fax No. :
0-
(xi). Mobile No. :
7073763316
(xii). Website (if any) :
NIL
(xiii). Legal status of User Agency :
Central PSU
A-3.
Details of Person Making Application
(i). First Name:
Krishan
(ii). Middle Name:
NIL
(iii). Last Name:
Lal
(iv). Gender:
Male
(v). Designation:
Dy General Manager
(vi). Address 1:
Hindustan Petroleum Corporation Limited , Jodhpur Retail Region, Bhagat ki Kothi , Diesel Shed Road, Jodhpur
(vii). Address 2:
NIL
(viii). State:
Rajasthan
(ix). District:
Jodhpur
(x). Tehsil:
Jodhpur
(xi). Pin:
342005
(xii). Landmark:
NIL
(xiii). Email Address:
gautamchanddoshi@gmail.com
(xiv). Landline Telephone No.:
0-
(xv). Fax No.:
NIL
(xvi). Mobile No.:
7073763316
(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.
Barmer Territorial
0.0435
0.0655
Total
0.0435
0.0655
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
Barmer
0.0435
0.0655
Total
0.0435
0.0655
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Barmer Gadan
0.0435
0.0655
Total
0.0435
0.0655
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Deceleration Lane
0.023
0.01275
2
Front Side (Service Road )
0.0025
0
3
Acceleration Lane
0.018
0.01275
4
Proposed Retail Outlet
0
0.04
Total
0.0435
0.0655
C.
Maps of forest land proposed to be diverted
Division 1. : Barmer Territorial
(i). Area of forest land proposed to be diverted(in ha.) :
0.0435
(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.
0.023
View File
2.
0.0025
View File
3.
0.018
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:
NH-68 side land is declared as protected forest St
E.
Employment likely to be generated
(i). Whether the Project is likely to generate employment ?:
Yes
(ii). Permanent/Regular Employment(Number of persons):
9
(iii). Temporary Employment(Number of person-days):
150
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? :
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
1
LOI LETTER
2
APPROVED LAYOUT PLAN
3
MORTH PERMISSION
4
Area Calculation Sheet
5
CERTIFICATE FOR MINIMUM USE OF FOREST LAND
6
CERTIFICATE TOWARD MUCK DISPOSAL AND MANAGMENT PLAN
7
Details of Permanent Employment to be Generated
8
JUSTIFICATION FOR LOCATING THE PROJECT IN FOREST AREA
9
LAND DOCUMENT
10
NH JAMABANDI COPY
11
JAMABANDI COPY
12
PROJECT RE REPORT
13
STATEMENT SHOWING DETAILS OF FOREST AREA PROPOSED FOR DIVERSION
14
UNDERTAKING FOR CONSERVATION OF FLORA-FAUNA AND WILDLIFE ANIMALS DURING APPROACH ACCESS CONSTRUCTION
15
UNDERTAKING FOR FRA CERTIFICATE
16
UNDERTAKING FOR NO HIGH TENSION LINE
17
UNDERTAKING FOR LP GAS GODOWN
18
UNDERTAKING FOR MUCK DISPOSAL DURING CONSTRUCTION OF APPROACH ACCESS
19
UNDERTAKING FOR NO CHANGE’S IN STATUTORY POSITION OF DIVERTED FOREST LAND
20
UNDERTAKING FOR PAYMENT OF ANY OTHER COST AND CONDITION
21
UNDERTAKING FOR PAYMENT OF COST OF COMPENSATORY AFFORESTATION
22
UNDERTAKING FOR PAYMENT OF NET PRESENT VALUE OF FOREST AREA
23
UNDERTAKING FOR SITE SELECTION and DISTANCE BETWEEN RETAIL OUTLET ON EITHER SIDE
24
UNDERTAKING FOR USE OF ANY MATERIAL FROM SURROUNDED FOREST
25
UNDERTAKING FOR WASTE MANAGEMENT DURING CONSTRUCTION ACTIVITY
26
PATTA SUPER IMPOSED
27
Geo-Referenced DGPMS Required Land Coordinates with proposed Retail Outlet
28
Map Showing Geo-Referenced for Survey of India Toposheet With Proposed Retail Outlet Full Toposheet No 40 O/6 Scale 1: 50000
29
Geo-Referenced Google Imagery Map with proposed Retail Outlet
30
EDS Reply HPCL -07-09-2021
31
BAR CHART
32
Power of Attorney KL 19Nov19
33
STATEMENT SHOWING DETAILS OF NON-FOREST AREA PROPOSED FOR DIVERSION
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