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. . ' EN'YIP.ONMG�TAL Cf1ECKLIST .
<br /> , (S�O.00 Fee Required) •
<br /> Entroduction: The State Environmental Polt:y Act of 1971, ChaptPr 43.21C, RC:J, .-eqsgres all
<br /> state and local gove�rnmental agencies tc �onsider environr_ental values both for thelr o�.-.
<br /> acr.ions and vhen licensing private pre.posals. The Act also requires that an EIS be prep�red
<br /> :or all ma.jar actions significantly aifecc3ng the quality of the environoent. The purpos=
<br /> af this checklist is to help the agencies involved determine whether or not a proposal is such
<br /> a major action. .
<br /> Please answer the following questic,ns as complete2y as you can with the informat3on preseztly
<br /> available to you. idhere esplanati-ons of your answers are required, or ahere you believe �a
<br /> explanation would be helpful to gavernment decision makers, include your explanation in t�e
<br /> . spac� provided, or use additional pages if necessary. You should include references to �y
<br /> reports or studies of which you are avare and crhich are relevant to the answers you provi'_e.
<br /> Comnlete answers to these questi.ons now will help all agencies involved wi[h your proposa:
<br /> to undertake the required environmental review without unnecessary delay,
<br /> The following questions apply to your total proposal, not just to :he license for which ycu
<br /> .ece currently apply3ng or the proposal for wt;ich approval is sought. Your answers should
<br /> include the impacts which wiil be caused by your propasal chen it is completed, even thou:n
<br /> campletiCon may not occur until sametime in the future. This will allow a11 of the a3enci=s
<br /> which Will be involved to coaplete their environmental review now, G.ithout duplicating
<br /> paper work in the futu�e.
<br /> NOTE: This is a standard form being used by all state and local agencies ia the State of
<br /> Wash3ngton for various t��pes of proposals. Many of the questions may not apply to your p:oposal.
<br /> If a question does not apply, just answer it "no" and contiaue oa to the ' ext: question._ _
<br /> ciiVZRONi`SENTAL CFiFC'nZIST FORM rl j= Ilg j;= r ;rj j� :'ij
<br /> r __ ` •' �� �
<br /> 4. BACKGROUt:D '� �. :. ,'� ��%�
<br /> �
<br /> Y. Name of Proponent ��� ;i,/� ��n,,�K,i.� CITI' r.c Ly�r .y.. ,
<br /> �i,i
<br /> 2. Addres3 and Phane Nimber of Proponent: _ �. ' r ` •-•i��. j L>> A ' , I
<br /> �l . ('-�.'w`-�J t'/.�-r- _ c. " .( � �' ikr
<br /> � ✓ �' .'�7 C C'cJ '— �7 — _ ' j!�C'c� ' `��e.�f
<br /> . �
<br /> 3. Date Checklist Submitted�C =_� (�. 7�; '
<br /> 4. Agencp Yequiring Checklist_� ,;�� ..� �"� , - ,:,� y_ �=� �_�._ '�,�
<br /> 5. Nam� of Proposal, if applicable: �_..
<br /> ,
<br /> 6. Nature and Brief Description of the Proposal (including but not limited to its si:a, �
<br /> general design elements, an� other factors that crill give an accurate understandicg
<br /> O� �[S SCO[70 and nature) : (� � ,�,�_:;,�,. �� �,�-r , ,, �::� ,�( �.�+
<br /> Cc.-. � ?i �. ' _ c� ._ '" _
<br /> '�i � � i—=: - s�� — L.c. .� _ �'� ..rl/ A '
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<br /> 7. Location of Proposal (descsibe the physical setting of the proposal, as well as CF.e
<br /> extent of the .land area affected by any environmencal impaccs, including any othe:
<br /> 3nfoxu�ation �eeded to give an accurate understanding of the environmental setting oF
<br /> the propcsal) ' • .� ; �, ,., . _
<br /> �`�' . '' �� � 1 Yi � ••r' . 7(] '�/ n. ; �_...c'.1 Li-� L-
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<br /> T' . _ / l- i_ • .:c .�r� -x� ..� ��a •r, a . .
<br /> M` ( ., f� ,. %. . /�._
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<br /> 8. Estimated Date For Completion of the Proposed Action: i_��-:;C. �-%.+.., �._
<br /> • , , _. .� ; '%..^ —
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