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�• <br />� �� <br />ENVIRONMENTAL CHECKLIST <br />Pqrpase of Cheeklist: <br />',j� / � .. i � <br />The State Environmen[al Palicy Act (SEPA), chap[er 47.21C RC`H, requira all governmennl agencies to consida <br />the environmental impacu of a propmai 6efare making decisiona. An environmentsl impact sn[ement (E1S) musc ba <br />preparcd for all propouls wieh probable signifiunc adverse impacu on che quali[y of �hc environmenc. The purpose ot <br />this checklist is to provide infortnatian [o help you and che ageney iden[ify impact�t From your proposal (and [o reduea <br />or avoid impacu from [he propcual, if i� ean be done) and to help the agency decide whaher an EIS is required. <br />lnstructions for Appliancs: <br />This environmental checklis[ asks you to dacribe some basic informacion ahoue your proposal. Governmental agen- <br />cia use this checklist to deeermine whaher che environmeneal impaccs of your propasal are significant, requiring <br />preparation of an E1S. Answer'the quaeions briefly, with the mosc prccise informacion known, or.give che bes� de- <br />scription you can. <br />You must answer each quaeion accurately and carefully. [o the hat of yaur knowledgc. [n mos[ cua. yau should <br />be able to an�we� the ques�ians from your own observa�ions or projecc plans wi�houc che need �o hire experu. If you <br />�really do no[ know the answer, or if a quation doa noc apply to your proposal, write 'do not know' or 'doa not ap- <br />ply'. Complece answen to the quations now may avoid unnecasary delays lacer. <br />Some quasions ask aboui governmeneal regula�ions, such as zoning, shoreline, and landmark daigna�ions. Answer <br />ehrse quations if you ean. If you have prablem�, the governmenwl agencia can assist you. <br />The checklist quations apply to all parts of your propaul. even if you plan to do them over a period of cime:or on <br />different parrels of land A[tach any additional information that will help dacribe your peoposal or iu environmencal <br />efi: �c. T,e agcary to whic6 you submi� this checklisc may ask you to explain your answen or pmvide addicional in- <br />Formation casonably related co detertnining if there may be significant adverse impact <br />Uu of cheeklut (or nonprojecc propauLs: <br />Complete this checklist for nonproject proposals, even �hough quationi may be answered 'doa not apply.' IN �o- <br />OITION, COrtIPf.CtO �:1C SUP�CEMENTAL SHEE7 FOR VONP0.0JECT ACT10N3 (p'dR D). <br />For sonproject aceions, the referenca in the checklis[ eo [he words 'project.' 'applicant,' and 'property or site' <br />should ba read as 'propaaal.' 'proposer.' and 'afFected geographic area,' rapectively. • <br />A.e�cxcRouNo <br />I, Yame of proposed project. if applicablr. <br />�M�Hne�z 12or�e�.��,K <br />? Vame of applicant: �.0�,°jEi� �,,. `J�[�l�J�`f ��.�•�•�TV�� 1� 1 wl � , <br />3. Addras and phone number of applican[ and contact person: <br />l�Igl�-T =�yl'I`r — 62'l �D�O3lv <br />s�ol t-t�•6.w�9 q8115 <br />4. Da[e checklist prcpared: 1���� <br />5. Agency requating chakli�r. (� ,t'`rp� �/�jrL{xijr p�.%'�"� h'��� b��. <br />6. Proposed �iming or sche�ule (including phasin , d applicable): <br />11•�a•°IZ �� F'��� dy {=ol��Hn�rl�rytT� I°«d-I• <br />���;.'S•��y pfl,6 Fot''. N61�1'1lT Pole �To �Y. I°�I-�I't�YN'�pL6�L �°v <br />;;. � . � .<or��tx�.icn�no�+o� �a.rro y�.wu3 �u�c�: Y <br />�• I•`t3Q�:t.ip�+++�f o� +°�UTo ��12-VI�P I�I,b�ot-t PPd¢!-�I. Y�.. <br />? Do you have any plans for future addi[ions, expansion, or further ac[iv�cy related to or conncned wuh this proposal^ <br />I` <br />ya. exp ain. <br />`(�ii �l,t{t.i.,'e6 b�/�I,DI�M6f'9T o� I°�cl°G�L G�4T-Ft6 Cm1-NF�I� � <br />bVtsle.�ti' �:I.l� W�i �. �i ��v6. k.l�(; To n�'6- t�lo'fB�t� <br />t-t�l�� !7�l�ti ��1.6G�l�b� <br />