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�, <br /> . , ($25.00 ree Required) <br /> Introduction: The Stnte �nvironmental Policy Act of 1971. <br /> Chapter 4a.21C, RCW, requires nll state and local governmental <br /> • , agencies to consider environmental values both for thwir own <br /> actions and when licensing private proposals. Th�J9�.1 also <br /> � requires that un E[S be prepared for all major acrions significanUy <br /> af[ecting the quality of the environment. The purpose of this <br /> checklist is to help the agencies involved detr_rmine whether or not <br /> a proposal is such a major action. <br /> Please answer the following quesfions as completely as you can <br /> � with the information presenUy availabxe to you. SVhere explanutions <br /> � ' of yous answers are required, or where you believe an explenation <br /> would be helpfui to government decision makers, include your <br /> explanution in the space provided, or use additional pages if <br /> necessary. You should include references to nn'q reports or studies <br /> of which you are aware and �vhich are relevant to the answers you <br /> provide. Complete answers to these quesiions now will help all , <br /> . agencies involved with your proposal to'undertake the required <br /> environmental review without unnecessary delay. <br /> The follotving questions apply to your total proposal, not just to the <br /> � license for tvhich you are currently applying or the proposal for <br /> witich approval is sought. Your answers should include the impacts ' <br /> which will be caused by your proposal when it is completed, even ` <br /> though completion may not occur until sometime in the future. This � <br /> tvill allow all o£ the agencies svhich tivill be involved td rnmplete , � <br /> their environmental revie�v now, without duplicating paperwork in <br /> � the future. � � <br /> ' ' NOTE: This is a standnrd form being used by all state and local I <br /> agencies in the State of{Vashington for various types of proposals. <br /> Many of the questions may not apply to your proposal. If a question <br /> � dces not apply, just answer it "no" and continue on to the next <br /> question. <br /> ENVIRONh1ENTAL CHECKLIST FORDi <br /> I. BACKGROUND <br /> 1. Nume of Proponent �A -�ic ���i+ TieN /�w' �' z <br /> 2. Address nnd Phone Number of Proponent: <br /> �-Ycc f/cuJ. T �"1'c l✓r,2FT i✓,�1N <br /> v�S� - �/> a <br /> 3. Date Cliccl:list SuUmitted - — .7 <br /> r <br />