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12.Village Panchayats, Zilla Parishad, MunicipalCorporation, Local body (complete postalAddress with telephone nos. to be given)Village Panchayat – Nardaha,Block – Arang,District - Raipur13.14.Name of the applicantRegistered AddressAddress for correspondence:NameDesignation (Owner/Partner/CEO)AKSHAY KUMAR SHRIVASTAVAC-43, VIP Estate, Khamardih, ShankarNagar, Raipur(C.G.),(492001)Village Post – Nardaha, Block-Arang, District – Raipur(C.G.),(493111)AKSHAY KUMAR SHRIVASTAVAOwner15.AddressPin CodeE-mailTelephone No./Mobile no.Fax No.C-43, VIP Estate, Khamardih, ShankarNagar, Raipur(C.G.),(492001)492001akshay.shrivastava2411@gmail.com9425203162/9039952246-16.Details of Alternative Sites examined, if any.Location of these sites should be shown on atopo sheet.Village-District-State1. Nardaha – Raipur- Chhattisgarh2. Behnakadi – Raipur- Chhattisgarh3. Dhansuli – Raipur- Chhattisgarh17.Interlinked ProjectsN/A18.Whether separate application of interlinkedProject has been submitted?N/A19.If yes, date of submissionN/A20.If no, reasonN/A2
21.Whether the proposal involves approval /clearance under: if yes, Details of the sameand their status to be given.(a) The Forest (Conservation) Act, 1980?(b) The Wildlife (Protection) Act, 1972(c) The C.R.Z. Notification, 1991?N/A22.23.Whether there is any Government Order/Policy relevant/ relating to the site?Forest land involved (hectares)NONO (Forest land not involved)24.Whether there is any litigation pendingagainst the project and /or land in whichthe project is propose to be set up?(a) Name of the Court(b) Case No.(c) Orders/directions of the Court, if any anditsrelevance with the proposed project.NO Capacity corresponding to sectoral activity (such as production capacity for manufacturing,mining lease area and production capacity for mineral production, area for mineralexploration, length for linear transport infrastructure, generation capacity for powergeneration etc.,)(II)Activity1. Construction, operation or decommissioning of the Project involving actions,which will cause physical changes in the locality (topography, land use, changesin water bodies, etc.)S.No.Information/Checklist confirmation1.1 Permanent or temporary change in landuse, land cover or topography includingincrease inintensity of land use (withrespect to local land use plan)Yes/NoNoDetailsthereof(withapproximatequantities/rates, wherever possible)with source of informationdataNot Applicable3
Page 1: APPENDIX - I(See paragraph - 6)FORM
Page 5 and 6: 1.19 Closure or diversion of existi
Page 7 and 8: Details thereof (withapproximate qu
Page 9 and 10: 6.3 From construction or demolition
Page 11 and 12: etc.)• housing development• ext
Page 13 and 14: NOTE:1. The projects involving clea
Page 15 and 16: c.Dumper/Tipper/Diesel TractorLoad-
Page 17 and 18: . Expected quantity of top soil(yea
Page 30: Akshay Kumar ShrivastavaNardaha,Ara
Page 40 and 41: Proposed Environment Management Sch

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APPENDIX â I (See paragraph â 6) FORM 1 (I) Basic ... - Seiaacg.org