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Short Environmental Assessment Form
Part 1 « Project Information
Part { ~ Project Juformation, The applic
ant or profect sponsor ig responsible for the completion
application for approval or fan ding, are subject to of Part 1. Respo
inéormation curently available, ££ additional resear public review, and may be subject to further verification, nses become part of the
ch or Investigation would be needed to fully respon Complete Part | based on
thoroughly as possible based on current d to any item, please answer as
information,
Complete all items in Part 1, You may also
provide any additional Information which you
lead agenoy; attach addittonal DAgES aS Neces believe will be neede d by or useful to the
sary to supplement any item.
Part { ~ Project and Sponsor Iaformat
ion
Name of Action or Project: i) 0 l, f- |
Ni K/ y
Project Location. fdesoribe, and Attach a logat
ion man);
Name of Applicant or Sponsor:
bo Ll
Telephone
Lackaweate beste Deaelopmert (acpor
tion . ; BaMall: ac 7 Ile jew § Lig) hy
éorpullly.or
City/
{ PO : Lackanaaly
| me
ate: V Zipjaz
Code:
i
!. Does the proposed action only involve
the legislative adoption of'a plan, local
adnlnistative rule, or regulatlon? law, ordinance, NO YES
If Yes, attach a narrative deserl ption of the intent "
of the proposed action and the environmental resou
may be affected fn the municipality and
proceed to Part 2. if ho, continue to quest rces that NG [7]
2, Does ion 2, |
the proposed action requite a permit, approval
If Yes, or funding from any other government Agenc
list gpenoy(s) name an permit or approval: y? NO YES
N tw Vor ¢ Homes ald Community Peteni |
.
3. a, Total acreage of the site of the propo
sed
b, Total acreage to be physically disturbed? action? ae
Ld | Ix
acres
¢, Total aoreage (project site and any tl Bares
contiguous properties) owned
or controlled by the applicant or project
spongor? fo
nate acres
4, Cheek ail land uses that occur on, are adjoi
ning or near the propased action:
5. [7] Urbaa [| Ruvai (non-ageleulture) = 7] Industrial [7] Commerctal I Residentiat (suburban)
L] Forest ["] Agricutture {| Aquatle [7] Other(Specify):
[7] Parktand
Paws | of 3
_ SEAF 2016