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Short Environmental Assessment Form
Part I - Project Information
Iustructions for Completing
Part | ~ Project Information. Fhe applicant ar 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 verificatio
information currently available, If additional research or investigation would be needed to fully respond n. Complete Part | based on
to any item, please answer as
thoroughly as possible based on current information. . :
Complete all items in Part |. 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
“Name of Action or Project:
storage Aut} 08
Project Location (describe, and attach & location map):
BoP Ste Mb £AISIG 73
Brief Description of Proposed Action:
Rout 1 concoe Rad,, Wels andl sie rar builds on
Sagas SIG
Name of Applicant or Sponsor;
Sweet [Ge UC ea
Telephone:
Address:
© legislative adoption ofa plan, local jaw, 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 4 [|
may be affected in the municipality and proceed to Part 2. [f no, continue to question 2.
_ a
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:
al CI
3, a, Total acreage of the site of the proposed action? 4:45 acres
b. Total acreage to be physically disturbed? _ iPad acres
c. Total acreage (project site and any contiguous properties) owned
or controlled by the applicant or project sponsor? g habs acres
4, Check all land uses that occur on, are adjoining or near the proposed action:
[J Urban [7] Rural (non-agriculturey PY Industrial [J Commercial [} Residential {suburban)
Cl Forest [] Agriculture [7] Aquatic [2] Other(Specity):
[7] Parkland
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