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/MH/MIS/64518/2017    ii. MoEFCC File No. : NIL    iii.Short narrative of the project: Proposed Sonawade-Ghodge, Nardev-Shivdav Road Passing through the Districts of Sindhudurg and Kolhapur, Maharashtra    iv. Project Sector : INFRA-2    v. Company/Proponent : PUBLIC WORKS SOUTH DIVISION KOLHAPUR

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Maharashtra	Sindhudurg	Kudal
2.	Maharashtra	Kolhapur	Bhudargad

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 06 May 2017 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: 06 May 2017   v. Uploaded Additional Report/Study/Document as desired by Ministry/EAC: None   vi. Uploaded Cover Letter: Annexure-Cover Letter   vii.Remarks: NIL

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : Sr.No. 103, List of Accredited Consultant Organiza    iii. Name of Consultant: MITCON Consultancy and Engineering Services Ltd   iv. Address : MITCON Consultancy and Engineering Services Ltd Environment Management & Engineering Division, Agriculture College Campus, Next to DIC office, Shivaji Nagar, Pune. 411 005, Maharashtra (India)   v. Mobile No.: 9665043400   vi. Landline No.: 02066289400   vii. Email Id: southkolhapur.ee@mahapwd.com

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 : Executive Engineer    ii. Designation : Executive Engineer    iii. Name of Company(Applicant Name should not be given here) : PUBLIC WORKS SOUTH DIVISION KOLHAPUR    iv. Address : Bandhakam Bhavan, Tarabai Park, Kolhapur 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