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/UP/ROAD/13414/2015   (ii). Name of Project for which Forest Land is required : Widening of “Gola- Shahjahanpur” section of State Highway No. 93” from Km 0.000 to Km 49.000 of SH-93 in Lakhimpur Kheri district and from Km 49.000 to Km 59.000 of SH-93 in Shahjahanpur district of Uttar Pradesh   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Gola-Shahjahanpur section of SH-93 from Km 0 to Km 59 in Uttar Pradesh has been selected for widening to standard two lane configuration under UPCRNDP. A total of 57.098 ha. (55.10 ha. of PF and 1.998 ha. RF) forest land will be required for widening.   (iv). State : Uttar Pradesh   (v). Category of the Proposal : Road   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 20650   (viii). Area of forest land proposed for diversion(in ha.): 57.098   (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): 30
A-2. Details of User Agency
  (i). Name : PWD   (ii). Address1 : Office of the Chief Engineer, World Bank Projects (Roads), Nirman Bhawan, 96, Mahatma Gandhi Marg, Lucknow-226001 (UP)   (iii). Address2 : Office of the Project Director, SRP-2 Circle (World Bank), UP PWD Lucknow, Nirman Bhawan, 96, Mahatma Gandhi Marg, Lucknow-226001 (UP)   (iv). State : Uttar Pradesh   (v). District : Lucknow   (vi). Pin : 226001   (vii). Landmark : Opp. Raj Bhawan   (viii). Email address : cewbuppwd@gmail.com   (ix). Landline Telephone No. : 522-2236496   (x). Fax No. : 522-522   (xi). Mobile No. : 9450900552   (xii). Website (if any) : http://uppwd.up.nic.in/wbprojects.html   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Shri   (ii). Middle Name: Rakesh   (iii). Last Name: Verma   (iv). Gender: Male   (v). Designation: Superintending Engineer   (vi). Address 1: Office of the Superintending Engineer, World Bank Yojana Circle, PWD, Nirman Bhawan, 96, Mahatma Gandhi Marg, Lucknow-226001 (UP)   (vii). Address 2: Office of the Superintending Engineer, World Bank Yojana Circle, PWD, Nirman Bhawan, 96, Mahatma Gandhi Marg, Lucknow-226001 (UP)   (viii). State: Uttar Pradesh   (ix). District: Lucknow   (x). Tehsil: NIL   (xi). Pin: 226001   (xii). Landmark: Opp. Raj Bhawan   (xiii). Email Address: cewbuppwd@gmail.com   (xiv). Landline Telephone No.: 522-2236496   (xv). Fax No.: 05222236556   (xvi). Mobile No.: 9454275527   (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.Forest Division, South Kheri49.0980
2.Social Forestry Division Shahjahanpur80
Total57.0980
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Lakhimpur Kheri49.0980
1.Shahjahanpur80
Total57.0980
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Gola1.450
2Kanja1.30
3Belwa0.90
4Dhirawan0.80
5Govinpur0.850
6Preli4.050
7Jungle No. 132.8980
8Seetla pur Grant0.950
9Pipara Dhani3.10
10Bhudiya0.550
11Lkhha0.950
12Padriya1.20
13Dayantpur2.30
14Islamabad2.150
15Dilawarpur20
16Mohammdi4.050
17Babauri0.90
18Sahdewa1.250
19Dharampur1.20
20Shankarpur1.250
21Mohammadpur Kala1.30
22Gokeran Pipari2.050
23Baireccha30
24Macchecha2.550
25Mohammadpur Tajpur2.650
26Japnapur0.640
27Mukrampur1.680
28Pipriya0.840
29Bhawal Khera1.120
30Diyuriya0.720
31Karaudha har0.680
32Hathaodiya1.360
33Hathada Bujrug0.960
34Mamri3.440
Total 57.088 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Forest required for road widening in Lakimpur Kher49.0980
2Forest required for road widening in Shahjahanpur80
Total 57.098 0
C. Maps of forest land proposed to be diverted
Division 1. : Social Forestry Division Shahjahanpur
  (i). Area of forest land proposed to be diverted(in ha.) : 8   (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).
1.8    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:
Division 2. : Forest Division, South Kheri
  (i). Area of forest land proposed to be diverted(in ha.) : 49.098   (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).
1.49.098    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: Improvement will be done on the existing road only
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 3000   (iii). Temporary Employment(Number of person-days): 1620000
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? : 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?: Yes   (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 ?: Yes   (a). Reason Category: CA Will be raised on degraded forest land as well as on land provided by User Agency   (b). Degraded forest area on which CA has to be raised by forest department(in ha.): 111   (c). Area of non-forest or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation(in ha.): 1.998   (iii). No. of districts involved for raising Compensatory Afforestation: 1   (iv). No. of patches: One
District 1. : Lakhimpur Kheri
  (a). Village: Landanpur Grant   (b). Area(in ha.): 2.165   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 2271   (e). Present owner: User Agency   (f). Copy of Ownership proof:
  (v). Scanned copy of the map of the land identified for creation of Compensatory Afforestation prepared by using GPS ot Total Station:   (vi). Copy of Survey of India Toposheet in 1:50,000 scale indicating location of the land identified for creation of Compensatory Afforestation:
Additional information Details
Documents
S.No Documents
Remarks
1Forwarding Letter
2Sanction Letter of the project
3Sample Linear Plan
4Undertaking for Eco-sensitive Zone
5Proposed RF area Shown in Forest Map (on SOI Toposheet)
6Gazette Notification for RF & PF at South Kheri and PF at Shahjahanpur
7Village wise breakup of forest land required for the project and remaining forest area
8SOI Toposheet (Scale - 1:50000) showing the proposed CA Area in degraded forest land for the diversion of PF in South Kheri Division of Lakhimpur Kheri District
9SOI Toposheet (Scale - 1:50000) showing the proposed CA Area in degraded forest land for the diversion of PF in Shahjahanpur District
10Geo-referenced map of the degraded forest land proposed for Compensatory Afforestation for proposed diversion of Protected Forest Land in South Kheri Division of Lakhimpur Kheri District & Shahjahanpur District, Uttar Pradesh
11Total Forest Area Proposed for Diversion