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r <br />�, <br />GNVIRONAiF.:1TAL CBECKLIST D � � � � `Yj � D <br />($'S6i00 Fee Required} � �� <br />' � OCT � �gg3 <br />troduction• The Seate Environmental Policy Ac[ of 1971, Chapter 43 �1C,�,R <br />tate and local ,,+ ����R'� all <br />gwernmental agencies to consider environment�l va�E+s�boNi fdY r wq <br />ac[ion� and when licensing private proposals. Tlie Act also requires tl�4�iin�I z prepazed <br />for all major actions significanely affectin� [he quality of che environment. 11�e purpose <br />of this checkllat is to help the agencies involved determine whether ar not a proposal is such <br />a major action. <br />� <br />Plase an�ver the following questions as completely as you can with ehe informa[ion presently <br />avaiLble to qou. Idhere explanations of your answers are required, or where yau believe an <br />qcplanation would be helpful to governmen[ d�cision makers, include your explanation in the <br />apace prwided, or use additional. pages iF necessary. You should ?nclude refetences to any <br />zeports or atudiea of which you are avare and c:hich are relevant [o ehe answers you pzovide. <br />Complete_ansvere to ehese questions now vill help all agencies involved vith your proposal <br />to•uttdartalu the required environmental reviev without unnecessary delaq. <br />'fh� folloving qusationa apply to your total proposal, not just to ehe licease for w6ich you� <br />are currently applying or the proposal for which approval is sought. Your answers should <br />include tha l�acts vhich will be ca�sed by your proposal vhen it is cocrpleted, even [houg6 <br />coupletloa may not occur until sometime in the Euture. This will allow all of the ngencies <br />vhich will be involved to cor�p.lete their environmental review nov, vithout duplicating <br />paper vork in the future. <br />NOTE: Thia Ss a standard form being used by all scate and local agencies in the State ot <br />Wuhington for various types af proposals. Afany oE the questions r�ay not apply to your propo�al. <br />If a que�tioq doea not apply, just anstoer it "no" �nd cantinue on to the next question. <br />EtiVIRONHENTAI, CHECKLIST FORM Af��4 a R�a2� <br />1. HACRCROU.iD � S L S � Ul'.�L.G 2�� W fl-� <br />1 <br />2 <br />3. <br />4. <br />5. <br />Name of Proponent_ �J�(ZIZ`�{ t�E Y,�u�`f� <br />Address and Phone �umber of Proponent: 3�j`'— ?�j'($ <br />1�lr:� 3�CD• Fl.✓E. �� G• E�/G-�.f�T? �'rVk�sl� c'17� 20¢ <br />Date Checklis[ Submitted 10 � — S?� <br />Agency Bequiring Checklist �i/F�, TT" (�LIIfi�Ili�G�� Z�/�///�/�j <br />Name of Proposal, if applicnble: <br />6. Nature and Brief Description of the Proposal (includinq but not limited to ita eist� <br />general design elements, and other fac[ors that will give an accurate understaading <br />of its scope and nature) : tN-I`� ( b a hi nl;� t,R hroRY r oNi . IJ,i�i u o �s�n �, <br />7. Loca[ion of Proposal (describe [he physic�l setting of the proposal, ae vell ae the <br />extent of the land area affected by any em�ironment�l impacts, including any oth�t <br />information needed to give an accurate understanding of ehe environmental setting of ' <br />the proposal) : "'-' �.� .t _ � � L i _ � o - DIJ hfGLj !fK/i9-Y �l �T GU/77f �Iti(9[L <br />���UB ��KU�� �r�_ �•, . ._• . <br />. __, <br />8. Estimated Da[e far Completion of the Proposed Actiun: M�Y �°� fjt�- ^ �' <br />_ _ __ _ .-\\�-_ .. <br />� <br />"� <br />- <br />