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<br />i
<br />4. Agency P.equiring Checklist
<br />5. N�me of 1'roposnl, if applicaUle:
<br />6. Nnture und Brief Description of the Proposal lincLu�.��b �u� •��•
<br />limited to its size, general design elements, and other factors
<br />that will give an nccurate understanding of its scope and
<br />nnture)' .� "l' , %`�/��� • �� �� .. � ;., ��;
<br />�, . / �
<br />�: �' �f / c �- � i
<br />7. Location of Proposal (describe the physicai se�u�,s �� ���
<br />. proposal, as tivell as the extent o£ the land area atfected by anY
<br />environmental impacts, including any other information needed
<br />to give an accurate understanding of the environsnental setting
<br />' osal) � �,:., ,-.�:,�.. ,..
<br />of the prop ,, �-"�� ,/�� S/� r 1
<br />, . _ . ,._ i; . . . . .. . . , l; � ,. . �
<br />8. Estimuted Date for
<br />Proposea e
<br />.,,;,.,,/! i.�.�•.;,-� ,,,r � , , . , � P rovals Required
<br />9. List of all Permits, Licenses or� Government A p
<br />for the Proposal (federal, state and local--including rezones):
<br />.� ,, ,.,;=/� � i'„��-i>i
<br />. �•.✓:. ,�,-
<br />10 . Do you have any plans for future additions , expansion , or
<br />further ucfivity related to or connecced with this proposnl? If
<br />yes, explain: �, _
<br />11 Do you know af any plans by others
<br />property covered by your proposal?
<br />:ir
<br />rhich may auecc
<br />If yes , explain:
<br />12. Attach any other application form that has oeen c�,��Y.�•�u
<br />regarding fhe proposal; if nonc has been completed, but is
<br />expected to be filed at some future date, describe the nuture
<br />of such application form:
<br />x: i' _
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