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/UK/WATER/64675/2020   (ii). Name of Project for which Forest Land is required : Jeevangarh Peri Urban Water Supply Scheme   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : This scheme will provide drinking water to jeevangarh peri urban areas, who are suffering from drinking water shortage.   (iv). State : Uttarakhand   (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) : 4890.06   (viii). Area of forest land proposed for diversion(in ha.): 0.18   (ix). Non-forest land required for this project(in ha.): 0   (x). Total period for which the forest land is proposed to be diverted(in years): 15
A-2. Details of User Agency
  (i). Name : UTTARAKHAND JAL SANSTHAN   (ii). Address1 : Dehradun   (iii). Address2 : NIL   (iv). State : Uttarakhand   (v). District : Dehradun   (vi). Pin : 248007   (vii). Landmark : Dehradun   (viii). Email address : sanju8165@gmail.com   (ix). Landline Telephone No. : 0-   (x). Fax No. : 0-   (xi). Mobile No. : 9837209733   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: S   (ii). Middle Name: K   (iii). Last Name: Srivastava   (iv). Gender: Male   (v). Designation: AE   (vi). Address 1: Manitenance Division, Uttarakhand Jal Sansthan, Lane no 1, Tarun Vihar, Mothrowala Road, Dehradun   (vii). Address 2: NIL   (viii). State: Uttarakhand   (ix). District: Dehradun   (x). Tehsil: Dehradun   (xi). Pin: 248001   (xii). Landmark: Dehradun   (xiii). Email Address: sanju8165@gmail.com   (xiv). Landline Telephone No.: 0-   (xv). Fax No.: NIL   (xvi). Mobile No.: 9837209733   (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.Soil Conservation,Kalsi0.180
Total0.180
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Dehradun0.180
Total0.180
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Ambari0.090
2Prithvipur0.090
Total 0.18 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Ambari & Prithvipur0.180
Total 0.18 0
C. Maps of forest land proposed to be diverted
Division 1. : Soil Conservation,Kalsi
  (i). Area of forest land proposed to be diverted(in ha.) : 0.18   (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).
1.0.18    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: Nil
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 0   (iii). Temporary Employment(Number of person-days): 100
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
1Justification Certificate
2Part-I to V
3Site Inspection Report
4GEO Referance Map
5Digital Map
6Alternative Allignment Certificate
7Minimum Cutting of Trees Certificate
8Land Schedule
9Certificate Project Length and Width
10Bar Chart
11Work Not Started Certificate
12Details of Affected Certificate
13Details of Affected Trees Civil Swayam Land and Van Panchayat
14NPV Certificate
15Certificate for Cutting of Banj Trees
16Certificate for No National Park and Wild Life Sanctuary
17Certificate for Distance National Park and Wild Life Sanctuary
18To Whom So Ever It May Concern
19FRA
20Componentwise Details
21Layout of the project
22Geological Report
23Task Force Certificate
24Standard Condition
25No Religious place Certificate
26Certificate for no affected Flora and Fauna
27Certificate for Supply Kerosine Oil and LPG for Labour
28Beneficiary Village
29NO Violence of FCA 1980 Act
30Muck Disposal
31Joint Inspection report
32Authority Letter