FORM - B
Form for seeking prior approval under Section-2 of the proposals by the State Governments and other authorities, in respect of renewal of leases,
which have been earlier granted clearance under Forest (Conservation) Act,1980
PART - I
(To be filled up by User Agency)
A. General Details
A-1. Project Details
  (i). Proposal No. : FP/KA/IRRIG/28934/2017   (ii). Name of Project for which Forest Land is required : Diversion of 2.16813 Ha of Forest land for Veerabhadreshwara Lift Irrigation Scheme in Chitrabhanukote, Nagnapr, Laxanatti and Dadanatti villages of Mudhol taluka, Bagalkot Dist in favour of KNNL   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Under Veerabhadreshwara Lift Irrigation scheme - Rising main pipe line passing through forest land in Chitrabhanukota,Naganapur, Laxanatti & Dadanatti village of Mudhol taluka in Bagalkot Dist   (iv). State : Karnataka   (v). Category of the Proposal : Irrigation   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 37837   (viii). Area of forest land proposed for diversion(in ha.): 2.16813   (ix). Non-forest land required for this project(in ha.): 21.5312   (x). Total period for which the forest land is proposed to be diverted(in years): 50
A-2. Details of User Agency
  (i). Name : KNNL   (ii). Address1 : Office of Executive Engineer GRBCC Division5, Kaujalagi   (iii). Address2 : taluka goka   (iv). State : Karnataka   (v). District : Belgaum   (vi). Pin : 591227   (vii). Landmarks : GRBC Colony   (viii). Email address : grbcdiv5@gmail.com   (ix). Landline Telephone No. : 273211   (x). Fax No. : 273211   (xi). Mobile No. : 9632871717   (xii). Website (if any) : knnlindia.com   (xiii). Details of Proposals seeking prior approval of Central Government under the Act for diversion of forest land submitted by the User Agency 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
  (xiv). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Basavaraj   (ii). Middle Name: Shekhraddy   (iii). Last Name: Patil   (iv). Gender: Male   (v). Designation: EE   (vi). Address 1: Office of Executive Engineer , GRBCC Division5, Kaujalagi   (vii). Address 2: taluka gokak   (viii). State: Karnataka   (ix). District: Belgaum   (x). Tehsil: Gokak   (xi). Pin: 591227   (xii). Landmarks: grbcc colony   (xiii). Email Address: grbcdiv5@gmail.com   (xiv). Landline Telephone No.: 273211   (xv). Fax No.: 08334273211   (xvi). Mobile No.: 9632871717   (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:
A-7. Details of the forest land returned back to the State Forest Department or any other Authority from the forest land diverted in favour of the user agency
A-9. Details of Transfer of Lease
Serial No Name of person Address of person Date of transfer MMDR File Transfer Deed Conservation MoEF_file No Date of approval MoEF file
NIL
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
  (i). Whether any proposal seeking prior approval of Central Government under the Act for diversion of forest land required for the project has been submitted in the past?. : No
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.Gokak02.6459
2.Bagalkot2.1681318.8853
Total2.1681321.5312
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Belgaum02.6459
2.Bagalkot2.1681318.8853
Total2.1681321.5312
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Chitrabhanukote Sy No 621.33721.6125
2Nagnapur Sy No 800.11353.6046
3Laxanatti Sy No 940.0373.0406
4Dadanatti Sy No 790.68047.9361
5Hebbal02.4177
6Hosakote00.2738
7Udapudi01.8925
8Bidaki00.7534
2.1681 21.5312
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Pump house00.2625
2Pipe line(Rising Main)2.1513321.162
3Surge Tank0.01680
4Delivery Chamber00.105625
Total 2.16813 21.530125
C. Maps of forest land proposed to be diverted
Division 1. : Gokak
  (i). Area of forest land proposed to be diverted(in ha.) : 0   (ii).Shape of forest land proposed to be diverted : Linear   (b). No. of Segments : One
Segments wise details
Segmenst Segment Area(in ha.) Kml File of SegmentsTo view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.0    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 DGPS or Total Station:
Division 2. : Bagalkot
  (i). Area of forest land proposed to be diverted(in ha.) : 2.16813   (ii).Shape of forest land proposed to be diverted : Linear   (b). No. of Segments : One
Segments wise details
Segmenst Segment Area(in ha.) Kml File of SegmentsTo view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.2.16813    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 DGPS 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: Yes   (a). Copy of map indicating location of alternative examined:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 12   (iii). Temporary Employment(Number of person-days): 404500
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? : 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). Provide reasons thereof: NIL   (b). Area of non-forest or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation:(in ha.) 5.665   (iii). No. of districts involved for raising Compensatory Afforestation: 1   (iv). No. of patches: One
District 1. : Bagalkot
  (a). Village: Mugalolli   (b). Area(in ha.): 5.665   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Sy No 25/1A   (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 DGPS 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
1CA Land Suitablity Letter
2Ownership
3CA Land Co-Ordinates
4Alignment of Veerabhadreshwar Lift Irrigation Scheme approved by KNNL
5Undertaking Letter
6Chitrabhanukote Forest Land Co-Ordinates
7Naganapur- Laxanatti Forest Land Co-Ordinates
8Dadanatti Forest Land Co-Ordinates
9Dadanatti Surge Tank Forest Land Co-Ordinates
10CA Land Village Map and Topo Map Merged
11Administration and Technical Sanction Letter
12Area Statement of Forest Area
13Area Statement for Non-Forest Area
14Authorisation Letter
15Bear the Cost of Compensatory Authority
16Beneficiaries of Project
17Brief Note of Project
18DC Letter for FRA
19DC Letter for No-Alternate land Non-Forest
20Forest Boundry Marked in Geo Referenced Maps
21Index Alignment Map
22DC Letter for CA Land
23CA Land Topo Map Merged
24CA Land Village Map Merged