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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 Part | based on application for approval or finding, are subject to public review, and may be subject to further verification, Complete information currently available. If additional research or investigation would be needed to fully respond te 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 Spo a Information ‘\ \\age Yeu, Name of Action or Project: Project Location aeVitlaoe Pla and attaach locatfon map): . V i l a g e a, __— (oi? “Botkalo el fasr Antone ~s 40D. ~k Sans n wc a of Proposed Action xp yr r as a y eC o v r y e r a n d open pote o ON Oy, (VV QUE RenY Name of Applicant or Sponsor: Telephone: #/ 7) Se Li} 7 | SSS Casey waCar Radress: IO5 drers Emir OSOY@ VIAGe-P!o lnu t a 4O52 Zip ‘ode: NY : | State: Avorn pr Aa) Easy CityPO: |. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NO 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. Ifno, continue to question 2. 3. Does the proposed action require a permit, approval or funding from any other government Agency? \ NO : | Hf Yes, list ageney(s) name and permit or approval: TOU B08VG,,ime \@AP acresprNe* 1 3. a. Total acreage of the site of the proposed action? b. Total acreage to be physically disturbed? __o _ acres c. Total acreage (project site and any contiguous properties) owned vr controlled by the applicant or project sponsor? \. Ag _. Beres (4A 4. Check all land uses that occur on, are adjoining or near the proposed action: [~] Urban tun (non-agriculture) (_] Industrial me Commercial is Residential (suburban) [J Forest [C1] Agriculture ["] Aquatic [T] O8 her(Specify): | 62] Parkland Pape ). dads"oS «» i SEAF 2049