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' � � <br /> ENVIRONMENTAL CHECKLIST <br /> Purpose of Checklist: <br /> The Sta[e Environmental Policy Act (SEPA), chapter 43.21C RCW, requira all governmental agencia to consider <br /> the environmental impacts o(a proposal before making decisions. An environmental impact scatement (E1S) must be <br /> prepared for all proposals with probable signi�cant adverse impacu on the quality of the environment. The purpose of <br /> this checklist is to provide inFormation to help you and the agency identify impacu from your proposal (and to ;educe <br /> or avoid impacts from the proposal, if it can be done) and to help the agency decide whether an EiS is required. <br /> lnstructions for Applicants: <br /> This environmental checklist asks you to ducribe some basic information about your proposal. Governmental agen- <br /> cia use this checklist to determine whether the environmental impacts of your proposal ate signiFicant, requiring <br /> preparation of an EIS. Answer the questions briefly, wi[h the most precise information known, or give the bat de- <br /> scription you can. <br /> You must answer each quation accurately and carefully, to the but of your knowledge. [n most casa, you should <br /> be able to answer the quutions irom your own observations or project plans Without the need [o hire experu. If you <br /> really do noc know the answer, or if a quucion does not apply to your proposal, write 'do noc know' or 'dou not ap- <br /> ply'. Complete answers tu the quutions now may avoid unnecasary delays later. <br /> Some quutions ask abaut governmen[al regulatians, such as zoning, shoreline, and landinark designations. Answer <br /> chue qucstions if you can. I( you have problems, the governmental agenciu can assist you. <br /> The checklist quutions apply to all pans o(your proposal, even if yau plan to do them c�ver a period of time:or on <br /> diFferent parcels af land. Attach any additional informacion that will help ducribe your prcposal or its environmental <br /> efkcts. The agency to which you submit this checklist may ask you to explain your answers or provide additional in• <br /> (ormatian reasonably related to determining if there may be significant advene impact. <br /> Use of checklist (or nonproject proposa/s: <br /> Complete this chccklist for nonproject proposals, even though quations may be answered 'daa not apply.' Ix �o- <br /> DIT10N, COfI1PICIC I}I[ SUPPLEMENTAL SHEET FOR VONPROIECT ACTIONS (P2(t D�. <br /> For nonproject actions, thc reierences in the checklist to the words 'project.' 'applicant.' and 'property or site' <br /> should be read as 'proposal,' 'proposer,' and 'affected geographic area,' rupectively. <br /> A. BACKGROUNU , <br /> 1. Name of proposed project, if applicable: _ l�c�i�Ge�u G Ltc. f?1.DG <br /> 2. Name of applicant: 4p r -t R iL y E/i Pn/i�[-f.a— <br /> 3. Addras and phone number of applicant and contact person; <br /> _ /1�>>�i�.4n. i• �LC� WEr.Hn�'-- .FvEti'Fi 9f�Jc� ��t -�/c7 <br /> CXrrls_r; /.�r✓.�L.J���r� - asirt .�fu%.N rz�sr 9�>� � Js`-3-co-, <br /> 4. Date checklist prepared: �/a�/t'� <br /> 5. Agcncy requating checklisC IXCKNndC �'t�'; <br /> 6. Proposed timing or schedule (including phasing, i(applicablel: <br /> 7. Do you have any plans for future additions, ezpansion, or further activity related to or connected with this proposal? <br /> If yes, ezplain. <br /> ` �C <br /> �1��- <br /> �. . <br /> , <br />