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��, . <br />. • <br />,� . <br />�� <br />' F.NVIRO`1if•.N'fAL CAGC!:LIST } <br />� , ($50.00 Fee Required) � <br />V <br />ntroductic_n: The Seate F.nvironnent�l Policy Act oE 1971, Chapter 43.21C, RCSv', requires all <br />:f.aCe and local y,overnmental aqencies tosalssidThceAc[ra].sonreq�iresethattanfF.IStbeiprepared <br />ections and �+hen licensing pri�aCe P�ffecting the qualicy af the environment. The purpose <br />'.or all major actions si�niQiEantly ro osal is such <br />�f [his checklist is to help the agencies involved determine whether or not a~���'� �� tl <br />� major action. n�y <br />ou can with ���j i.��Ym on e,� y <br />'lcase answcr the folloaing questions as completely as y ou,b,elieve an <br />ivai�able Lo you. 1�fiere �c�:planations of your answers are required, <�Llahere yt��l�y,�n the <br />:xplanation c:ould be helpful to government uecision makers, include your $;�,�� <br />es if necessary. You should include Seferen �s. ����}e. <br />a <br />;�sc� provi.ded, or use additional pag o �o osal <br />YD P <br />ceports or studies of �ahich you are aware and which are relevant to th� '��4� b <br />:omplete anskere Ye uired environnental reviewe+ithout unnecessary del�y � h „A P P <br />to undertake th 4 <br />iha following questions apply to your total proposal, not just to the license fox which you <br />ste currently applying or the proposal for which approval is sought. Your answers should <br />include Che impacts �ahich will be caused by your proposal cahen it is completed, even [hough <br />conpletion may not occur until sometime in the future. This will allo�a all of the agencies <br />Whlch will be involved to complete their environmental review noev, without duplicating <br />paper work in the future. <br />f <br />; <br />i <br />used by all state and local agencies in the Seate o ro osal. <br />ro osals. ilany of the questions may not apply to your p P <br />NOTE: This is a standard form being <br />l�lashin��on for various typ�s °just ans�aer iC "no" .znd continue on to the next question. <br />If a question does not app•Y, <br />ENVIROii`fENT� CHECnLIST TORt•t . . , <br />1, BACKGROUPiD <br />1, Name of Yroponent PU =�1' si'u�"" <br />2. <br />3. <br />4. <br />5. <br />6.� <br />Address and Yhone Number of Proponent <br />. y7, 1960 <br />Date Checl:lisc Submltcea • r+•�--• . <br />pgency Sequir:ing Checklist___(:it�✓ oi Everet� • <br />Name of Proposal, if applicable: <br />si ze <br />and other factors that eoill give an accurate understanding <br />Nature and Brief Des�ri.pti.on of the Prunosal (including but noC limit.ed to its . <br />geueral design elements, ,'lo.r ,�.vy Y�•� „sis n�tients <br />of its scopc and naturc): ti�d -�l• <br />�ro esal, as wcll as tlie <br />an enviro:xnental iuip�cts, including any other <br />7, Location of Proposal (d�.scriue the pl'�)•sical sel•ti.n1; of t�e } P <br />crtent of thc l:�nd arc� aCfe�ted by Y <br />inEorn:ation n�..ded to l;ive �n accuratu underscandiug of the envi.ro�unenCnl srCtin1; o <br />tlie pcoposal)c North��•�'sC c� '�'�ssau �n�l 33rd Streetis, f>>ti Slti� <br />... _�..,.., i,,,,k �L• west edne of nrooertv. <br />---- ' osed AcCinn: I�e��'�z 19��- <br />g, l;::timared D:icc Eor Coroplctiun of Che Prop <br />1 <br />