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iNVIP.ON,17E:v'1'AL CiIECIiLIST <br />(�25.00 Fee f{equired) <br />����0��� <br />fE6 241�r� <br />Intro=t�on: Thc Stute Environmental Policy Act of 1971, <br />Chapter 43.21C, RCIV, requires nll state and locnl goverr.mentnT FI2o,� �� D p�'� <br />agencies to consider environmental vulues both for their oivn <br />actions rmd when licensing private proposals. The Act also <br />requires ihyt un �IS be prepared for all major actions significantly <br />affecting the quality of the environment. The purpose of this <br />checklist is to help the egencies involved determine whether or not <br />a proposal is such a major action, <br />Piease ansrver the following questions as completely as you can <br />with thc information preser.tiy availaUlc to you. SVhere eYplanctions <br />of your answers are required, or rvhern you belicve an explanation <br />would be helpful to government decision makers, include your <br />eacplanation in the space provided, or use additional pages if <br />necessery, You shouid include reierences to nny reporis or studies <br />of tvhich you are a�vare and which are relevant to the ansirers you <br />provide. Comolete ansrvers to these questions notiv 1��i11 help nll <br />agencies involved e:ith your proposal to undertake the required <br />environmentnl reviek• wiFhout unnecessary delny. <br />The fo;lotving questions apply to your total proposal, not just to the <br />license for v:hich you ai•c cur:ently applying or the proposal for <br />�vhich npproval is sought. Your answers should include the impacts <br />which will be caused by your proposal K•hen it is completed, even <br />though completion may not occur until sometime in the future. This <br />will cillo�•r all of the ngencies �vhich wiii be inv,olved to ccmplete <br />their environmental :evie�v now, without duplicuting paperwork in <br />the future. <br />NOTE: This is a standard form bei»g used by yil state and local <br />agencies in the State of Washington for various types of proposals, <br />�41any of the questions may not apply to your proposal. If a question <br />does not appiy, just anstiver it "no" and continue on to the nest <br />qupstion. <br />�WIRON1l1ENTAL CHECKLIST FORM <br />I. RACKGROUND <br />1• Name of Proponent'.'ztthi3 g� +,i��dan fer �I. John Killia.n <br />Z. Address nnd Phone Number �i Proponent: <br />o .. ... �-- <br />BOt}IC11� ;lt� <br />��_ <br />3• �g� Checklist SuUmitied <br />r <br />