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eg le PTH AP ACU OURSMHS pA : ee “Sethe proposed action. | &. A potmilted use under the zoning regulations? | imict Cl i : b. Consistent with the adupted comprehensive plan? I, a Cy | be nner ts . _ 6 Is the proposed retion consistent with the predominant character of the existing built or natural landsenpe? ; 7. Is the site af the proposed action located in, ov does it adjoin, a state listed Critical Environmental Area? I Yes, identity; ptm Pal Ll 'i NO | YES | 8. 4. Will the proposed action result in a substantial inorcase in traffic above present levels? b, Are public transportation services available at or near the site of the proposed action? ie Cl : ¢. Are any pedestrian accommodations or bicycle routes available on or nenr the site of the proposed ee Tj | tb action? 9. Does the proposed action meet or excced the state energy code requirements? NO | YES i Ifthe proposed action will exceed requirements, describe design features and technologies: 10, Will the proposed action connect to an existing public/private water supply? NO | YES If No, deseribe method for providing potable water: O 7 It. Will the proposed action connect to existing wastewater utilities? NO | VES If No, describe method for providing wastewater treatment: privat. Sst oh & 12. a, Does the project site contain, or is it substantially contiguous to, a building, archaeological site, or district NO YES which is listed on the National or State Register of Historic Places, or that hus been determined by the Commissioner of the NYS Office of Parks, Recreation and Historic Preservation to be eligible for listing on the ms State Register of Historic Places? b. Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for leat ; OO i archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory? 13, a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain oe we x is o i weilands or other waterbodies regulated by a federal, state or local ageney? m oo b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: pte [Zh T Page 2 of 4