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Short Environmental Assessment Form
Part 1 - Project Information
Part | ~ Project Information, The appltcant ox project sponsor is
responsible for the completion of Part 1. Responses become part
application for approval! or funding, fre subject of the
to public review, and may be subject to flurther vetlfication. Complet
e Part
information currently available, ff additional research
or investigation wauld be needed to fully respond to any item, please 1 based on
thoroughly as possible based on current information, answer as
Complete all Items {no Part 1, You nay also provide any additional information which
lead agenoy; attach additional pages as necessaty to supp you believe will be needed by or useful to the
lement
any item,
Pact I ~ Project and Sponsor Information
Name of Action or Projeot: NV p / Fe | NV W y
Project Location ae
232. Gibewook Gitle
and attach a location map);
Brief Desoription of PMéposed Action:
Name of Applicant or Sponsor:
Telephone
Laskar Hou Si Dale ter (orpordion E-Mail: 4c #f (Le jew§ Lid
Mo Fil, bol
) hdr pully.on
Lack kawedU l
City/PO:
WY
State:
| inot¥
Zip Code:
1. Does the proposed action only involve the legislative adoption
ofa plan, local law, ordinance, NO | YES
admlnistrative rule, or regutation?
If Yas, attach a narrative description of the intent of the proposed
action and the environmental resources that WG [|
may be affected in the municipal ity and proceed to Part 2.
Ifo, contlane to question 2, |
2. Does the proposed action require a permit, approva ;
l or funding from any other government Agency?
Mes York Siete.
If Yes, list age ines me and permit or approval: NO YES
3. a, Total acreage
Homms ald Community
.
of the site of the proposed action?
L
Leena Ll | IX
b, Total acreage to be phys ically disturbed? -{__.___ heres
¢, Total acreage (project site and any contiguous propert | acres
ies) owned
of controlled by the applicant or project sponsor?
_f aOres
4, Cheek all land uses that occur on, ate adjotning or
near the proposed action:
5. [] Urban Cj Rural (non-agticulture) [C] Industrial [1] Commercial A resident (suburban)
I] Forest [7] Agticulture [| Aquatic [Z] Other(Specify):
[1] Parkland
Pays 1 of 3 _ SEAF 2019