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I•n[roducGinn: 3'hc State 1.: virullmnital Policy Act c` 1971, Cli:,gter 43.7.1C, !t0 , rcy:.iires all
<br />state mtcl lorr,l I;overn:aenr_a] 1gent:lc:: to considor cnvironmcnl:,1 valuas both far t'"i ; v.:n
<br />actions and whc❑ licensing private proposals. 'i'hc Act alsorrcq^irrs chat an IilSnc f�If,'ced
<br />for a]i ra,lrr actions si;;nlCicautly affCCLIng the c:;,Ii.Ly o. t.i_ cnvirun�:enl, ,•• ,
<br />oC th)s checl:).ist is to help Lhe agencies involved '_eter:tine w6-:t!,cr or not a prc,;.•.'.al
<br />a majur action.
<br />Plcasr: :,n-•:ur the fuJ)owin); questions as cos�plcl.eJ arc you can ,:itll the Jnfurmati.,r ar,•sest_y
<br />nvailaiil,• to yno. t:hcre czplanatlons of your nns:r_r; are re;uinsl, or Y:hL•re you .,eve •}•
<br />iutt w.:t1J be Lt:Ipfni Lo guvc•rnreent dc•cisic.. --aker:e, incl.:dr: your etc, la^.ati•. i:: i?:e
<br />: or u::,: •!,:diLi.onyl pages if urr.ess;:'y `'nn s?:::.i•i include rc:[rcra�:: :r.
<br />spac•• pr vide:., rclevacl !p the ::..s-:.:rs
<br />r,:purts t-r r.t'; us of which you are aware aad w�tic' .. .
<br />CoupLotr. anSY:erS "
<br />latiyou:
<br />•;;Lu [].eso qucstions now wtit
<br />to reu__red enviror.:ental review wiG:..::unncrc%-ery ..
<br />The fo].]o•airg eues[ions apply to your total propos=:. not just v: the licensr `ch
<br />r :'.lcs .
<br />are clrrrc:.11y n�plyina o: Lhc pro;,osal for ::hich a':a1. is
<br />Sal
<br />inc]udc tiu• iz.�zcts which gill be caused b_: your F--.-:. Y:he:: _, is co-.;,letc•a, This :•`'L allow a:] of
<br />T'in
<br />t't,r _raaci_,
<br />cost, ).'ti�i.^. may not occct until soetin'
<br />2 the fut.:e. -
<br />which will be involver: to coaplete their e vi.ron:ce:.::i revieY: witho•c '.piit=: '=
<br />paper work in the future.
<br />is a standard fm'r being used by all -'=_:e and lccal agencies in the _.-te er
<br />NOTE: Vnis -- ^:ay not. a, ply ; _ur
<br />h'ashiro[on for ^.a:io:a types of Proposals. •:fan;• �_ [be quest__., .
<br />If a question does not apply,
<br />just answer it "no'�'- contim:2 �n to the ne::C goes=''-^n•
<br />F•NYL:ONi:F1:TAi. C1I CRUST FOAL
<br />I.. PACKCRO";D �
<br />�rV 'I C=': f•'r: itiJ� Li �.i+L c'iJ
<br />_—_
<br />,
<br />1. ];amc of Propnaen[ SYo77AL �'•)I.- Y7,1,._. — --
<br />2. Address and Phone Nu her of Proponent: ?=t�—':�?—�� -
<br />3. Pate Checklist---'"--
<br />4. A;;ency .eCui.riog Checklist-- : --- �r,f�rl �„•,•
<br />$. Nome of 1'rol•.osa1, iC
<br />L size.
<br />G. Nature and ];rief Pesr.ription of the Iro,.sa: (in ucling but n, limited to t.s:tdial
<br />•l:al will give au accurate uncle:':
<br />general drsigu clement::, an.l other factors _ _
<br />oC its .^.cop, :)
<br />and nature *•=��' `.«1_`tf.
<br />• t----` — _—__
<br />as flte
<br />7. Location of Proposal. ;describe the Physical-eC[ing of the proposal, as trek
<br />extent. of the• land area atfectel by any env ronmentai ia:parls, including ot'.ter _
<br />1 le cnvt.rona:ental
<br />t[nt needed to give nt :.. `C_ c•Vf ''F•f`T 1y01_ 7 ;.` :'y
<br />PLAT
<br />g, l::aitaatcd Uatc fin' Co❑plotion of the 1'ropca;d Action J----- --"—
<br />_J
<br />-t`� f
<br />
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