1.	Project Details

   Whether it is a violation case and application is being submitted under Notification No. S.O.804(E) dated 14.03.2017 ? : No

1.	Project Details

   i. Proposal No. : IA/GJ/MIS/75562/2018    ii. MoEFCC File No. : 11-23/2018-IA.III    iii.Short narrative of the project: CRZ Clearance for the proposed Construction of cable Stayed Bridge in coastal zone of Tapi River joining Adajan and Athwalines area of the Surat city by Surat Municipal Corporation    iv. Project Sector : INFRA-2    v. Company/Proponent : SURAT MUNICIPAL CORPORATION

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Gujarat	Surat	Surat City

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 05 Sep 2018 x.Project Type: New

2.	Uploaded Documents of EIA/EMP,Risk Assessment,Public Hearing etc.

i.EIA/EMP: Annexure-EIA/EMP ii.Risk Assessment: Annexure-Risk Assessment iii.Public Hearing: Annexure-Public Hearing    iv. Date of Public Hearing: 29 Aug 2017   v. Uploaded Additional Report/Study/Document as desired by Ministry/EAC: Annexure-Additional Report/Study/Document   vi. Uploaded Cover Letter: Annexure-Cover Letter   vii.Remarks: CRZ Report

Additional Attachments, if any
S.no.	Attached File	Date of Submission
1.	CRZ Map indicating HTL and LTL on 1:4000 Scale with Clear indication of project location superimposed	25 Jun 2018
2.	Form-I	25 Jun 2018
3.	Acknowledge copy of CRZ application submitted to GCZMA	25 Jun 2018
4.	EDS Reply	29 Jun 2018
5.	EDS reply - GCZMA recommendation for CRZ clearance	05 Sep 2018

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : NABET/EIA/1417/ IA 003    iii. Name of Consultant: Envision Enviro Technologies Pvt. Ltd.   iv. Address : 3rd Floor, Shri Ram Complex, Above Bank of India, Surat-Dumas Road, Piplod, Surat-395 007, Gujarat.   v. Mobile No.: 9428001875   vi. Landline No.: 02612223003   vii. Email Id: exen.bridge@suratmunicipal.org

5.	Undertaking

I hereby give undertaking that the data and information given in the application and enclosures are true to be best of my knowledge and belief and I am aware that if any part of the data and information found to be false or misleading at at any stage, the project will be rejected and clearance given, if any to the project will be revoked at our risk and cost.

   i. Name of Applicant : Bharat    ii. Designation : CityEngineer    iii. Name of Company(Applicant Name should not be given here) : SURAT MUNICIPAL CORPORATION    iv. Address : Mugalisara building Opp LIC main Office, Mugalisara main Road, Surat v. Uploaded copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency: Annexure-Uploaded copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency