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Short Environmental Assessment Form
Part 1 - Project Information
dustryctions for Completing
Pavt | ~ Project Information. The applicant ov project Sponsor
Is responsible for the complotion of Part L. Responses become
application for approval or fa nding, are subject to public part of the
review, and may be subject to further verlfication, Complet
informetion currently availabfe, If additional research ot investig e Part 1 based on
ation would be needed to fully respond to any ltom, please answer
thoroughly as possible based on curcent information, ag
Complete all items in Part 1, You may also provide any
additional information which you believe will be needed
lead agency; attach additional pages as necessary to supple by or usefii! to the
ment any item,
Part f ~ Project and Sponsor Information
Name of Ac
tion or Proj
ect: M ol, f ~
N NV
Project Location (describe, and attacl yggeation map); y
VARA
“Belef Deseription of Proposed Action:
Name of Applicant or Sponsor:
Telephon
Lackaisars tpusir; Daelophert lerpontion
blo Fi, bool
City/PO: i kY OG
Fama ae regen SEDI Warp
utyeg
{,
ALF au til
Does the proposed action only involve the legislative adoption
State:
WY lyzie
Zip Code:
ofa
plan, local law, ordinance, NO
administrative cule, or regulation? YES
If Yes, attach a narrative description of the intent of the propose
may be affected in the municipality and proceed to Part 2. If d action and the environmental resources that 4 [|
no, continue to question 2. |
2, Does the proposed action require a permit, approval or funding
from any other government Agency? NO
If Yes, listage a) name and permit or appyoval: .
YES
tw lor ite oles and Community Penewe ion
3. a. Total acreage of the site of the proposed action?
ef acres
Lt | Xl
b, Total acreage to be physically disturbed?
&. Total acreage (project site and any contiguous properti
a acres
es) owned
or controlled by the applicant or project sponsor?
if acres
4, Check all lanc uses that occur on, ave adjoining or near
the proposed action:
5. [Urban [| Rural (non-agricutture) [OT Industrial [-} Commercial A residentiat (suburban)
1] Forest CJ Agriculture [] Aquatic [LJ Other(Specify):
[] Parkland
Pao | of3 _ SEAF 2049