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103 DORN AVE 2016-01-01 MF Import
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103 DORN AVE 2016-01-01 MF Import
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Last modified
4/7/2017 6:15:07 PM
Creation date
2/12/2017 3:31:19 AM
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Template:
Address Document
Street Name
DORN AVE
Street Number
103
Imported From Microfiche
Yes
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(1g)' �ecren[Son. Will the proposal result in an impact upon the quality — ",� <br />or quantity of exiating recrea[ional opportunitiee° — <br />Explanation: <br />(20) Archeol�gical/Nistorical. Mill the proposal result in an alteration <br />of a significant archeol�g:-cal or historical site, structure, object �_ <br />or building? '— <br />Exp]anation: <br />III. SIGNATURE <br />I, the undersigned, state that to the best of my knowledge :he above information is <br />true and compiete. It is understood that the lead agency may withdraw any declaration of non- <br />aignificance that it might issue in reliance upon this checklist should there be any misrepresen- <br />tation or lack of full disclosure on my part. <br />� � • ��� <br />Proponent: � ��r�'/\ ^ �-" <br />C ���w��r��, �„�,;�-�` . <br />DECLARATION OF RESYONSIBLE OFFICIAI.: . <br />The above described project is a major action with (significant, insignificant) <br />impact and (will, will not) require an Environmental Impact Statement. <br />Responsible Official <br />F`] <br />
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