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A'-11; A)/��y V.. Y1� :I 1. Il.'' 1,. ,�.IMV.•i1)(r. `.,/. <br />LEA¢_ S 8 T ZP N 2SE <br />9. <br />Agency Requiring Checklist <br />5. <br />Name of Proposal, if applicable: /(.1/c// srp✓GE� <br />tax/ No�Y i,�ousrzi�S <br />G. <br />Nature and Brief ]Jescriplion of the Proposal (including but not <br />limited to its size, general design elements, and other factors <br />that will give an accurate understanding of its scope and <br />nature): G�vs-•Zuc _ Nc'w� Or�E 5ry, CV, lc W_41-,,C-Hr <br />777T-�t-l.✓G '4�'O Q_2� �' S4 � COr�TA1.c.'///� ¢2¢ �YQ7��y�r,C_LES <br />i/it.T� OuE Ui�-/.�/ /1�H.C)G�'S AFX�r'TN=�/•T . <br />7. <br />Location of Proposal (describe the physical setting of it/e <br />proposal, as well as the extent of the land area affected by any <br />environmental impacts, including any other information needed <br />to ; ive an accurate understanding of the environmental setting <br />of the proposal): Tt+E s,7 rs eL67-Wi./ �7< y eor4*- q.r) X S <br />�Ac-'> 41/LL 17c ro orza/inF Laiii�_ r <br />Csc-Ta r-t7 J �4r•��4JLL l3C f q i 4-)/A-TFTTr <br />Ei✓eco,� /rI/ <br />c(7 G e. L . I=Ehc� <br />B. <br />kstimated Date for (ompintion of the Proposyd Action: �,� <br />9. <br />List of all Permits, licenses or Government Approvals Requi ed 4 <br />_ <br />for the Proposal (federal, state and local --including rezon es): <br />•ST T �1" Hco yS <br />��"y� F/srrtrziEs , <br />10. Do you have any plans for future additions, expansion, or <br />further activity related to or connected with this proposal? If <br />yes, explain: Ycr <br />� .Sire ,co.� hr�E �drvi-.,=7cr�L f�uF-Lcl�-�r.�tir <br />11 Do ycu know of any plans by others which may affect the <br />property covered by your proposal? If yes, explain: NO <br />12. Attach any other application form that has been completed <br />regarding the proposal; if none has been completed, buis <br />expected to be filed at some future date, describe the nature <br />of such application form: <br />