Laserfiche WebLink
. �•, _ <br /> ' • • , ' ENVIRONMGNTAL CHECKLIST �°} �' "� �' � �� �S ��j <br /> � • .. . ,.'�J <br /> . � (�8.00 Fee Required) '?^• '� r.' � " <br /> J .... .. <br /> !"j�i• r.__ �._ ... <br /> . � L" Vi.il:.%�l� <br /> Introduction: The State Environmental Policy Ace of 1971, Chapter 43.21C, RCGI,,.requirea all <br /> state and local qovernmen[al agencies to consider environmental values both for their own <br /> actions and when licensing private proposals. The Act also requires that an EIS be prepared <br /> for all major actions significanely affecting the quality of the environment. The purpoae <br /> of this checklist is to help the agencies involved determine vhethe.r or not a proposal is such <br /> a major action. <br /> Please ansver the following queseions ar� completely as you can with the information presently <br /> available to you. UThere explanations of your answers are required, or where you believe an <br /> explanation erwld be helpful to• government decisian makers, include your c�•�lanation in the <br /> spac� provided, or use additional pages if necessary. You should include references to anq <br /> repor[s or studies of ahich you are a�;are and crhich are relevant to the answers you provide. <br /> Complete ansWers to these questions now will help all agencies involved wi[h your proposal <br /> to undertake the required environmental review without unnecessary delay. <br /> The following questions apply to your total proposal, nat just to [he license for which you <br /> are currently appl�ing or the proposal for which approval is sought. Your answers ahould <br /> include ehe impacts vhich will be caused by your proposal when it is completed, even though <br /> completion may not occur until sometime in the future. This will allow all of the agencies <br /> vhich will be involved to coc�plete their environmental review now, wiehout duplica[ing. <br /> paper work in the future. <br /> NOTE: This is a standard ,form being used by all state and local agencies in the State of <br /> t:ashington for various [ypes af pzoposals. Many of the questions may not apply to your proposal. <br /> If a question does not apply, just ansWer it "no" and continue on to the nexe questioa. <br /> , . . <br /> ENVIRONMENTAL CHECKLIST FORM <br /> 1. BAC?!GROUND <br /> 1. Name of Proponent_C C'J(Z1x��U �.J. �� jrSA IZ 13r1/2N /-� Si�t TH <br /> 2. Address and Phone Number of Proponent: d�}� [. j� � ^/,L , <br /> _���1 i77x WA� 4Fil.� 7-z�-�s�� <br /> 3. Date Checklis[ Submitted 4_�} _ .7� <br /> 4. �gency Requi.ring Checklist [�� j y �i= G/�L,QE'/' <br /> 5. Name oi Proposal, if appl3cable: �1�/�f,Qrl.v /7L.���_ � • <br /> 6. Nature and Brief Description of the Proposal (including but not lioited to its size, <br /> general design eleaents, and other factors that will give an accurate understanding <br /> of its scope and nature):_Z�NCL��T�C1V CI� �=,(����MF- �?�.��C,. '�'C �/=j=�CCS <br /> r�(!�c•x i7�icc �t� �=i eFr,cc� ('3 c.co'cts ) 5"!tc :c: 1°r. � - <br /> y �_ Cc':JriF�cv/cr j�•� �5 <br /> Q. 5'i c�4'rlC.-c I, l2e 54• 1`i, .c�r s i,�'i c.b 5 <br /> 7. Location of Proposal (describe the physical setting of the proposal, as well as the <br /> extent of the land area affected by any environmental impacts, including any other <br /> informatian needed to give an accurate understanding of the environmental setting of ' <br /> theproposal):�/. E, L'ti'.✓�'��.' �3�1•k`iiT 9 /Zt •c.C��� <br /> /�1c/ y��.�T1— • <br /> Lrc�lrTi , W,� , <br /> 8. Estima[ed Date :or Completion of [he Proposed Action: .�1:/✓G /�7`% <br />