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' . � �-�� •. . (� �. ENVIRONMENTAL CHECKLIST -� <br /> � � � � � % ($50.00 Fee Required) � •' � ' • <br /> ; � <br /> I <br /> Introduction: The State Environmental Policy Act of 1971, Chapter 43.21C, RC41, requires all � <br /> state and local governnental agencies [o consider environmental values both for their own � <br /> actions and when licensing private propo.;als. The Act also requires [hat an EIS be prepared ;• <br /> for all ma,jor actions •;ignifican[ly affe�^ting the quality of the environment. The purpose � <br /> of this checklist is to help the agencies involved determine whether or not a praposal is such <br /> a major action. <br /> Please answer. the following ques[ions as compler.e7; ss you can wi[h the information presently <br /> available to you. I,fiere explanations of your ans:rers are required, or where you believe an <br /> explana[ion would be helpful to government decision makers, include your explanation in the <br /> spac� provided, or use additional pages if necessar.y. You should include references to any <br /> repor[s or studies of which you are aware and whir.� are relevant to the answers you provide. <br /> Complete answers to these questions now will help all agencies involved with your proposal <br /> to undertake the required environ�ental review without unnecessary delay. <br /> � <br /> The following questions apply to your [otal proposal,� not just to the license for which you <br /> are currently applying or the proposal for which approval is sought. Your answere should <br /> include the impacts cahich will be caused by your proposal when it is comple[ed, even ttiough <br /> completion may not occar until sometime in the future. This will allow all of the agencies ; <br /> uhich c:ill be involved to coe�plete their envirunmental review now, without duplicating <br /> paper work in the future. , . <br /> VOTE: This is a standard form being used by all state and local agencies in the State of <br /> dashington for various types of proposals. 2fany of the questions nmay not appi}• to your proposal. <br /> Cf a question does not apply, just answer it "no" and continue on to L-he next question. <br /> iNVIRO`'MENTAL CHECKLIST FOR24 . . <br /> .. BACRGROUP7D . � <br /> 1. Name of Proponant�jGhARp W ���pIQRISt �AY�tes � �`-� ' <br /> 2. Address and Phone Number of Proponent: �a3.�' lS�SW Ff7iN�M95 �1`�aa� ' 7/�s'�5/7 <br /> p�e�5z naTw • epzn std9 aarmcl� ff 79�7�'S ex�sr�rni +4 ccn�TS 3 D�s�/eX t3169S� <br /> 3. � Date Checklist Submitted LI�N� al /Y� -- <br /> 4. , Agency Requiring Checklist -T'ic�.a'.eTf P�-�{„^i1`�7��� <br /> 5. Name of Proposal, if applicable:� � � <br /> 6. Nature and Brief Description of the Proposal (including but not limited [o i[s size�, <br /> general design elements, and other factors that will give an accurate understanding <br /> of its scope and na[ure) : POil��l� oF 3w��rs $�19 fIRR�EkiA1 � C5�'` �''�r' ) on SIT� <br /> P-'� '�.Med W171� 13�SD $ f' �R@�e T [uc :� DupIE'a- (ild�5 U Un�1"�i - 7brt��- <br /> ? G.nifi's p6u� l�w�drf ��o�i.•� wl,e.ri cv�os�.re- . <br /> 7. Loca[ion of Proposal (describe tti.. physical setting of the proposal, as well as the <br /> extenC of [he land nrea affected by any environmental impacts, ,including any o[her <br /> information necded to give an accurate understanding of the environmental set[ing of <br /> the propusal) :$�15 I��P�s+�(2d �h'`�') S�� 6zla-> ��npoE �� HwedP;xl2�- �rrhar�� <br /> e�, Ad�inv P�'cef 7bµs hws l�n�( u r n / e s;„ e „� � ct,.a rn, (�� �+�d ta-f <br /> ,S�'S��c Itmrk &���ril— Gu114 F „d�y —f/a��r=.km,2d c:kS�3a,�ndw! — �3 N<ns. S.�,ti��av <br /> B, Estimated Date for Campletion of the Proposed l�ction: . I <br /> .:l�T I 4$O I <br /> I _ `, <br />