APPENDIX VIII (See paragraph 6) FORM 1 M APPLICATION FOR MINING OF MINERALS UNDER CATEGORY ‘B2’ FOR LESS THAN AND EQUAL TO FIVE HECTARE. Basic Information (i) Name of the Mining “Granite Building Stone Quarry of Mr.Abdul Rahim” Lease Site Re-Survey No:- 147/46,147/2A1,147/2A2,147/42,147/43,147/44,147/41 Village:- Thazhakkode Taluk:- Kozhikode District:- Kozhikode State:- Kerala Pillar Latitude Longitude No (ii) Location/Site (GPS Co- BP 01 11°20'19.50"N 75°58'28.65"E Ordinate) BP 02 11°20'19.30"N 75°58'31.11"E BP 03 11°20'18.38"N 75°58'32.90"E BP 04 11°20'19.87"N 75°58'33.02"E BP 05 11°20'20.52"N 75°58'32.72"E BP 06 11°20'20.63"N 75°58'35.32"E BP 07 11°20'22.68"N 75°58'37.18"E BP 08 11°20'22.42"N 75°58'39.23"E BP 09 11°20'24.08"N 75°58'39.74"E BP 10 11°20'25.61"N 75°58'37.52"E BP 11 11°20'23.77"N 75°58'29.61"E (iii) Size of the Mining 3.8830Ha Lease (iv) Capacity of Mining 124256MT Lease (v) Period of Mining Lease 10 Years (vi) Expected Cost of 50 Lakh Project - 2 - Name Mr.Abdul Rahim Address S/o Moyin Kutty (vii) Contact Information Palakulangara House Manga Poyil Neeleswaram P.O Kozhikode-673582 E-mail Mob +919447111191 Environment Sensitivity Si No Areas Distance (KM) Distance of project site from Rail, Road Bridge over Agasthyamuzhi-Thiruvambadi Road Over 1 the concerned River, Rivulet, Nallah etc. Bridge-1.6 KM 2 Distance from infrastructural facilities Railway Line Kozhikode-27KM National Highway Kozhikode-Kannur-20KM State Highway Koyilandy- Edavanna-600M Major District Road Agasthyamuzhi-Kunnamangalam-1.6KM Other Road Mutheri Road-1.6KM Electrical Transmission Line or Pole Mutheri KSEB Transformer-450M Canal/Check Dam/Reservoirs/Lake/Pond Kakkayam DAM-50KM In-take for drinking water/pump house PHD Koolimad-10.5KM In-take for Irrigation canal pumps PHD Koolimad-10.5KM Areas protected under international conventions, 3 national or local legislation for their ecological, None within 1KM from project site landscape, cultural or others related value. Areas which are important or sensitive for Iruvazhinji River (Agasthyamuzhi)-1.6KM 4 ecological reasons – Wetlands, watercourses or Kozhikode Coastal Area -26KM other water bodies, coastal zone, biospheres, Thiruvambady Mountains-5KM mountains, Areas used by protected, important or sensitive 5 species of flora or fauna for breeding, nesting, None within 1KM from project site foraging, resting, over Wintering, migration 6 Inland, coastal, marine or underground Kozhikode Coastal Area -26KM Waters 7 State, National boundaries State Boundary (Kerala-Tamilnadu)-53KM 8 Routes or facilities used by the public for access to Thusharagiri-17KM recreation or other tourist, pilgrim areas Vellarimala Eco Tourism-17KM Kakkadampoyil Waterfalls-15KM 9 Defense installations None within 1KM from project site 10 Densely populated or built-up area, distance from 72.9M toward North West side from the area nearest human habitation - 3 - Areas occupied by sensitive man-made land uses Hospital:-Agasthyamuzhi-1.5KM (Hospitals, schools, places of worship, community Airport:-Calicut Airport -34KM facilities) School:-Pallotto School Agasthyamuzhi-1.3KM 11 Church:-Mukkam-2KM Mosque:-Manapoyil-600M Temple:-Vattoliparambu Temple-1.2KM Areas containing important, high quality or scarce resources (ground water resources, surface Thusharagiri-17KM 12 resources, forestry, agriculture, fisheries, tourism, Vellarimala Eco Tourism-17KM minerals) Kakkadampoyil Waterfalls-15KM Areas already subjected to pollution or environmental damage, (those where existing legal No 13 environmental standards are exceeded) Areas susceptible to natural hazard which Could cause the project to present environmental problems (earthquake, subsidence, landslides, No 14 erosion, flooding, or extreme or adverse climate conditions) is proposed mining site located over or near fissure/fracture for ground water recharge Whether the proposed involves approval or clearance under the following Regulations or Acts namely:- No (i) The Forest (Conservation) Act, 1980; No 15 (ii) The wildlife (Protection) Act, 1972; Not Applicable (iii) The Coastal Regulation Zone Notification, 2011 If yes, details of the same and their status To be given. 16 Forest land involved (hectares) No forest land involved Whether there is any litigation pending against the project and/or land in which The project is proposed to be set up? No (i) Name of the Court 17 (ii) Cash No. (iii) Orders or directions of the court, if any and its relevance with the proposed project - 4 - “I hereby given undertaking that the data and information given in the application & Enclosures & true to the best of my knowledge & belief & I am aware that if any part of the Data & information submitted is found to be false or misleading at any stage, the Project will be rejected & clearance gives, if any to the project will be revoked at our risk & cost”. Signature of Proponent:- Dr. Nazar Ahamed K.V DMG/KERALA/RQP/07/2016 Name: - Mr.Abdul Rahim Address: - S/o Moyinkutty Palakulangara (H) Date: 16.10.2018 Neeleswaram P.O Place:Kozhikode Kozhikode - 5 - .