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Short Environmental Assessment Form Part 1 - Project Information Instructions for Completing Part 1 – Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part 1 – Project and Sponsor Information 359 Quaker Road redevelopment Name of Action or Project: 359 Quaker Road minor site plan Project Location (describe, and attach a location map): 359 Quaker Road SBL (175.06-3-9) Brief Description of Proposed Action: Redevelopment of the site to include demolition and removal of existing wood frame building and new construction of dental office along with use of the existing parking area in the front of the building with modifications as necessary to improve traffic flow, pedestrian flow and safety. Connection to public water to remain. New connection to public sanitary sewer by sewer main extension. Name of Applicant or Sponsor: Telephone: 716-572-1127 PCW Enterprises LLC E-Mail: [email protected] Address: 4185 East Blood Road City/PO: State: Zip Code: Cowlesville New York 14037 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NO YES administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that ✔ may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other government Agency? NO YES If Yes, list agency(s) name and permit or approval: Aurora Town Board development approval Aurora Building Department building permit approval ✔ 3. a. Total acreage of the site of the proposed action? 0.7 acres __________ b. Total acreage to be physically disturbed? __________ 0.5 acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? __________ 0.7 acres 4. Check all land uses that occur on, are adjoining or near the proposed action: 5. Urban Rural (non-agriculture) ✔ Industrial ✔ Commercial ✔ Residential (suburban) □ Forest Agriculture Aquatic Other(Specify): □ Parkland Page 1 of 3