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.., _ � � <br />,� <br />..::; . <br />..,::; • <br />��: • ENVIRONMENTAL CHECKLIST . ✓ <br />�,�''� . <br />�it-'." ' (s50.OD Fee Required) <br />�...-~ � ' . . <br />a�:=: .: � . <br />. ����. . <br />_•--•-• <br />Introducticn: The State Environmental Policy Act of 1971� Chapter 43.21, RCW, <br />requires all state and lacal governmentel agencies to consider environmental <br />values both for their oWn actions end when licensing private proposals. The <br />Act also iequ.ires that an EIS be prepared for all major actions significantly <br />effecting the quality of the environment. The purpose of this checklist ia <br />to help the agencies involved determine ahether or not a proposal is such a <br />major action. • <br />Please ansWer the follouring questions as completely as you can with the information <br />preaently available to yau. Where explenations af your answers are required� <br />or where you believe an explanetion Wauld 6e helpful to government decision <br />makers� include your explanations in the space provided� or use additionel pages <br />if necessary. You should i�clude references to any reports or atudies of which <br />you are aWare and which are relevant to the ansWers you provide. Complete <br />anavrers to these questions nour Will help all ag�ncies involved With your proposel <br />to undertake the required environmental review Without unnecessary delay. <br />The following questions apply to �uu� total proposal, not just to the license <br />for Which you are currently epplyinq or the proposal for which approval is sought. <br />Your ansurers shauld include the impacts which will be caused by your proposal <br />When it is completed, even though completion may not occur until sometime in <br />the future. This will allb�r all of the agencies which will be involved to complete <br />their environmental revieur nour� Withaut duplicating paper Work in the future. <br />NOTE: This is a standard form being used by all state <br />the State of Washington for various types of proposals. <br />may not apply to your proposal. If a question does not <br />"no" and continue on to the next question. <br />ENVIRONMENTAL CHECKLIST FORM <br />and locel agencies in <br />Many of the questions <br />epply, just answer it <br />_■ i <br />1. BACKGROUND <br />1. Name of Proponent �����1a-'�1ef►�*'� � �����Tu"� <br />2. <br />3. <br />Address and Phane Number o� Proponent qT�S'S��'•.�/'%I �i'• <br />�rt� �_o�- r.4�-t� 15G�...1.� � ��r.... G�4a (�oco)2�.-�1�3 <br />Date Checklist Submitted � �Si �`1�� <br />q, Agency Hequiring Checklist G� �P` ��- .'���-'""'� �i.�tii�l�� <br />5. Name oF Proposal, if applicable o��(r-��ll /r!l�.rslf2l,c� <br />G� ��-� �v�`i`�- <br />