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-� . . t -- � :'..�s�--� <br /> � . ' iRONMENTAL CIfECKLIST. �� � �'� � r� � n <br /> • ; .. , . ''' <br /> (550.00 Fee Required) �-� <br /> , , ' D�T �. I''/� <br /> Introdvction: The State Envirunmental Policy Act of 1971, Chaptc�il��t.'2��R�T�y'��iT�'es all <br /> s[ate and local governmental agencies to consider environmental values";baIItn�nr. thcir own <br /> acti'ons and When licensing private proposals. The Act also requires that an EIS be prepared <br /> for all ma,jor actions signiticantly affectin� the quality of the environment. The purpose <br /> of this ctieckl3st is Yo help the agencies involved determine whether or not a proposal is such <br /> a aajor action. <br /> I Please answer the following questions as completely as you a�n with the information presenily <br />� available to you. 1,�here eaplanations of your answers are required, ar whcre you believe an <br /> explanation would•be helpful to government decision makers, include your e�plana[ion in [he <br /> kspac= provided, or use additional pages if necess�ry. You should include references [o any <br /> repor[s or studies of whi^h you are aware and which are relevant to the answcrs you provide. <br />�i Complete answers to these questions now will help all agencies involved with your proposal <br />� to undcrtake the required environmental review without m�nece�sary delay. <br />� The folloiaing questions apply to yovr total propo,al, not just to the license for which you <br /> are currently applying or the proposal for �+hich approval is sought. Your anscoers should <br /> include the impacts which will be caused by your proposa7. when it is comple[ed, even though <br /> N completion may no[ occur until so�oetime in the future. This will allow all of the agencies <br /> I which vill be involved to complete their environmeutal review noa, without duplicating <br /> paper Work in the future. <br />� � - <br /> NOTE: Tliis is a standard form being used by all state and local agencies in the State of <br /> 4)ashington for carious types of proposals. :fany of the questions flay non apply [o yuur proposal. <br /> If a question does not apply, �ust answer it "no" and continue on to the next question. <br />� E:WIROVMEYT4L CNECKLIST PORM <br />� 1. BACKGROUND J <br />� 1. Rame of Proponent (��j/ [.//��L .� � �C� . <br />' 2. Address and Phone t�umber of Proponent:��, Q �O�t ) l � l ��r,,Zir�,'7-- <br />, LUM. 9LZoCo 2v� -�,�9,,,- SIB 6 . — <br /> 3. Date Checklist Submitted 1 <br /> 4. Agency Requiring Checklist• 1 � O F �QiYL.�fi1�% <br /> 5. Name of Proposal, if applicable: /��j�/[/tiC. LvT G,�� �GK `� . <br /> 6. Nature and Brief Description of the Proposal (including but not limited to its size, <br /> general design elements, and other factors thal• will give an accurate �nderstanding <br /> of its scope and nature) : �j'7 u icU �.lY�//i,�Y� /nT . � <br />' � I �b �n ��-� <br /> 7. Location of Proposal (descriUe tlie physical setting of the proposal, as well as tlie <br /> , extent oE the land area aftected by any environmental impacts, inc.luding any other <br /> infonnation needed to give an accurnte underslanding of .the environmental setting of <br /> thc proposal) :��- �G .� Sa �,L, ?�dvc/ Z,�,�� /��A-i .ft� .C�/P�Zr�� <br /> 8. Estim:ited Date for Completion oE tli� Proposed Action: �� �� <br /> i <br />