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• � . <br /> • ($25. 00 Fee Required) • <br /> Introduction: The State Environmentn: :olicy Act af 1971, <br /> Chapter 43.21C , RCW, requires all state and locnl governmental <br /> ngencies to consider environmentnl vnlues both tor their own <br /> nctions and when licer,sing privatc. propos;ls. The Act elso • <br /> requires that nn EIS be prepared for nll major netions significm�Hy <br /> affectin� the qunlity of the enviror.ment. The purpose of tl�is <br /> checklist is to help the ngencies involved determine wt�etlicr or not <br /> a proposnl is such a major acHon. <br /> Pleuse answer the follo�ving ques:ions ns completely ns you can <br /> with the informntion presently nvailuUle to you . iVhere explanntIons <br /> of your �nstivers nre requlred, or �vhere you believe en expinnntion <br /> would be helptul to government decisiom m�Jccrs, include your <br /> explanation in tlie spnce provided, or use additionnl peges if <br /> necessary. You should include references t.� nny rnports or studies <br /> of whtch you are awnre nnd which nre a•elevan! to the answers you <br /> provide. Complete unswers to these yuestions 7ow will help all <br /> agencies involved with your proposal to undertuke the required <br /> environtnental review withoutunnecessary delay. <br /> The following questions apply to your total proposal, not just to the <br /> license for which you nre currently npplyin¢ or lhe proposnl for <br /> K hich approvnl is sought. Your unswers should include the impacts <br /> whic4 wi11 Le cnused by your proposnl whrn it is completed, even <br /> though completion may not occur until sometime in the tuture. ., is <br /> will allotv nll of the agencies which �vill be involved to complete <br /> their environmentel review no�v, without duplicnHng papecwork iri <br /> the fulure. . <br /> NOTE: Thi3 is n standurd [orm being used by nll stnte and local <br /> agencies in the State of Washington for vurious types ot proposnls. <br /> Many of the questions mny not apply to your proposal. If a qvestion <br /> does not apply, just nns�,ver it "no" nnd continue on to the next <br /> question. <br /> ENVIRONMENTAL CHECKLIST FORM <br /> I. BACKGROUND <br /> 1. Name of Proponent _Mrs• ,l�jnna L. SchPnk <br /> 2. Address and Phone Nu,nUer ��.` Yroponent: <br /> 1022 West Lasino Rc�ad <br /> N207B - Everett, WA 982U4 <br /> 353-4423 _._ <br /> 3. Dete Checiclist Submitted <br /> •,. <br /> f' <br />