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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 iZodAame ¢ Cock, Choe Shook Swe wm ssi on Name of Action or Project: | U Crcse, sivdl Project Location (describe, and attach a location map): Sheol [Ux 2s} lo CON an Nie ob ced Brief Description of Proposed Action: CG nCe. Pre Noe iW) AS* Brinn \nenSs-e Name of Applicant or Sponsor: Zocvanne 9 Cocly Cres E-Mail: Address: 4 - ! oe. . OMNer). “ cit ‘ ? COm hts WW rokla nd “Drive City/PO: State: Zip Code: POY [Yoo lt A\ VOD Om 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 CI] 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: Tok eda Nepr L]| Kl 3. a. Total acreage of the site of the proposed action? ~ «S62. acres b. Total acreage to be physically disturbed? .001 acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? _SLBZ acres 4. Check all land uses that occur on, are adjoining or near the proposed action: [[] Urban [[] Rural (non-agriculture) [_] Industrial [7] Commercial EX Residential (suburban) [_] Forest [-] Agriculture [] Aquatic [_] Other(Specify): [| Parkland Page | of 3 SEAF 2019