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Short Environmental Assessment Form
Part I - Project Information
ustructions for Com pleting
Part 1 ~ Project Information. ‘Fhe applicant
or project sponso
r is responsible for the completion of Part
application for approval or fin ding, are subject to 1. Responses become part of the
public rev lew, and may be subject to further verlftc
information currently available, If additional resear ation, Complete Part 1 based on
ch of investigation would be needed ta fully respon
thoroughly as possible based on current
information,
d to any item, please answer as
Complete all items in Part 1, You may also provid
e any additlonal Information which you believ
lead agency; attach additional pages as necess e will be needed by or useful to the
ary to supplement any item,
Part I — Project and Sponsor kuformation
| Name of Action or Project: Ni } \ Fe | N
A) y
Project Lovatio describe, and attach a location map):
yewosk Cin @ lat |
Brief Desoription ofProposed Action:
| Name of Applicant or Sponsor:
Telephone:
Larkawenm, Hhusity Datlopmert Lerpoution
_| Malt) Ae NG Le, je Sei the Corpully.ory
_ ble bi, L Leal
City/PO: ) U
Lackawatty __
States Zip Code:
{. Does the proposed action oly invelv e the legislative adoption of a plan, local law, ordinay WzreNO
administrative rule, or regulation? nce, YES
If Yes, altach a narrative description of the intent of
may be affected in the mun icipality and proceed the proposed action and the environmental resources 4
to Part 2, [f ho, continues to question 2. that KI [4
2. Does the proposed action require a permit, approv |
If Yes, list age oe) ngine ary or appyov al or funding from any other government Agency?
Mew York
NO YES
Stete. “Heme ta Community Penewe
al: \
3, @. Total acreage of the site of the
proposed
b, Total acreage to be physically disturbed? action? el acres
Lt | [x
¢. Total acreage (project site aud any conti ef acres
guous prope
or controlled by the applicant or project sponsor? rties) owned
i acres
4, Check all land uses that occur on, are adjoi
ning or near the proposed action:
[1 Urban (CJ Rurat (non-agricuiture) [7] Industrial [7] Commerctal 12 Resiconti (suburban)
["] Forest [] Agriculture [| Aquatls [7] Other(Specify):
[—] Parkland
Paws | of 3
_ SEAF 2019