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PENDUDUK TERKENA DAMPAK

DAFTAR PERTANYAAN

RENCANA PEMBANGUNAN SUKARAJA III DAM KAB. LAMPUNG TIMUR

ASPEK SOSIAL EKONOMI DAN SOSIAL BUDAYA

RESPONDEN

Nama : ..........................................................................

Alamat Responden

a. Dsn!L"n#$n#an : ..........................................................................

%. Desa!Kel&a'an : ..........................................................................

(. Ke(amatan : ..........................................................................

I. Identitas Responden

Nama Responden

Jen"s Kelam"n La$") Pe&empan

Um& Ta'n

A#ama *"nd Islam K&"sten Bd'a

Stats Responden Ka+"n

Belm $a+"n

Alamat

Desa

Ke(amatan

Pend"d"$an SD SLTP SLTA PT

Pe$e&,aan Utama PNS ABRI Petan" Nela-an

K E M E N T E R I A N P E K E R J A A N U M U M

D I R E K T O R A T J E N D E R A L S U M B E R D A Y A A I R

SATUAN KERJA BALAI BESAR WILAYAH SUNGAI MESUJI SEKAMPUNG

PEJABAT PEMBUAT KOMITMEN PERENCANAAN DAN PROGRAM

Jl.Gatot Subroto No.50 Telp.(0721)!1"!0 #a$.(0721)!1%7 &a'ara*pu'+ , -510

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/ La"nn-a

Pendapatan pe&%lan

Rp

Jmla' o&an# dalam $elaa :

La$") Pe&empan

,"+a J"+a

II. SIKAP DAN PERSEPSI RESPONDEN TERHADAP PROYEK

. Sm%e& a"& %a$ d" desa %apa$!"%!sada&a %e&asal da&"mana0

A"& *,an) Mata A"&! Sn#a"! Dana

1

2

Sm& #al"!Sm& %o&

PDAM

). Apa$a' ada "nstalans" -an# men#al"&$an a"& %a$ te&se%t0

-at"da$

1. Apa$a' man3aat da&" a"& %a$ te&se%t0

Ke%t'an '"dp pendd$) I&"#as" sa+a'

1

2

Ke%t'an te&na$

I&"#as" tem%a$a

2. Apa$a' d" desa %apa$!"%!sada&a te&dapat Bendn# ata Bendn#an0

-at"da$

4. Apa$a' %apa$!"% men#eta'" $ala d" dae&a' "n" a$an d" %at Bendn#an0

-a t"da$

a. 5a6 S"apa -an# men#"n3o&mas"$ann-a0

%. T"da$6 alasan

)

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7. Apa$a' ada sos"al"sas" men#ena" Pem%an#nan Bendn#an0

a T/a

8. J"$a 5A6 mate&" sos"al"sas" -an# d"sampa"$an anta&a la"n?

Pem%e%asan la'an

) *aa la'an

1 La"nn-a:999999999999999999999999

999999999999999999999999

. J"$a te&,ad" pem%e%asan la'an6 apa$a' la'an -an# d"m""$" d",al $epada p&o-e$0

-a t"da$

a. 5a6 Alasan-a 999999999999999999999999999999999999999

%. T"da$6 alasan 9999999999999999999999999999999999999999

Kala t"da$6 apa$a' %apa$!"%!sada&a ma d"%e&"$an la'an pen##ant" d" tempat

la"n0

a. 5a6 alasan-a 999999999999999999999999999999999999999

%. T"da$6 alasan 9999999999999999999999999999999999999999 J"$a 5a6 dae&a' -an# d""n#"n$an0 9999999999999999999999999999999

;. Se'%n#an den#an adan-a &en(ana Bendn#an6 apa$a' ada $e$a-aan!'a&ta %enda

%apa$!"%!sada&a -an# d" %e%as$an $a&ena $ena p&o-e$0

ada t"da$ ada6 J"$a ada6 se%t$an:

Jen"s

$e$a-aan U$&an!las N"la" 'aa ,al

Rp.

) Rp.

1 Rp.

2 Rp.

4 Rp.

1

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B. Data Kekayaan Responden

. Ban!"nan

. Rma'

Jen"s %an#nan pe&manen me+a' pe&manen %"asa

sem" pe&manen non pe&manen

la"nn-a6 se%t$an 9999999999999999999999999999

Las %an#nan m)

Stats $epem"l"$an m"l"$ send"&" se+a

m"n,am

.) La"nn-a6 %an#nan: 9999999999999999999999999999

Jen"s %an#nan pe&manen m+a' pe&manen %"asa

sem" pe&manen non pe&manen

la"nn-a6 se%t$an 9999999999999999999999999999

Las %an#nan m)

Stats $epem"l"$an m"l"$ send"&" se+a

m"n,am

.1 La"nn-a6 %an#nan: 9999999999999999999999999999

Jen"s %an#nan pe&manen m+a' pe&manen %"asa

sem" pe&manen non pe&manen

la"nn-a6 se%t$an 9999999999999999999999999999

Las %an#nan m)

Stats $epem"l"$an m"l"$ send"&" se+a

m"n,am

2

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Apa$a' %an#nan -an# %apa$!"%!sada&a tempat" se$a&an# te&$ena p&o-e$

pem%an#nan Bendn#an0

5a t"da$

J"$a -a6 $emana %apa$ a$an p"nda'0

p"nda' $e tempat la"n6 dlm sat desa

p"nda' $e tempat la"n6 $e la"n desa

La"nn-a:9999999999999999999999

9

#. Tana$

). Tana' pe$a&an#an

Las a&e

tats tana' S*M PPAT Lette& C Pato$

La"nn-a 99999999999999999999999999

,en"s pa#a& tem%o$ $a- %am% la"n:9999999999999

pan,an# m t"n##" m

).) Tana' sa+a'

Las a&e

tats tana' S*M PPAT Lette& C Pato$

La"nn-a 99999999999999999999999999

).1 Tana' sa+a' tada' ',an

Las a&e

tats tana' S*M PPAT Lette& C Pato$

La"nn-a 99999999999999999999999999

).2 Tana' $e%n

Las a&e

tats tana' S*M PPAT Lette& C Pato$

La"nn-a 99999999999999999999999999

).4 La"nn-a 99999999999999999999999999999

4

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Las a&e

tats tana' S*M PPAT Lette& C Pato$

La"nn-a 99999999999999999999999999

%. Pete&nakan

1. Sap" e$o& Las $andan# m)

,en"s $andan# pe&manen sem" pe&manen non pe&manen

p&od$s"!'as"l Rp. pe& %lan!ta'n

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p&od$s"!'as"l Rp. pe& %lan!ta'nsa&an: 999999999999999999999999999999999999999999999999999999

8