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617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 - Project Information. The applicant or 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 verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. 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: . Lecréec Hara PP vle bec Project Location (describe, and attach a location map): Flo Gra \ebeg> pA Brief Description of Proposed Action: 32% Ho! pore bern cout Bi jem-t he Vector ryioncA use arc to act 4&5 ow CK jee a Arcng Cur delat cA-&S Name of Applicant or Sponsor: Telephone: i b -42 4. S24 > ChhAS & ChAstirn [Ce Fe E-Mail: Ce coi g weP Cyr a. con Address: | wo (310 GvodlebLec fd. City/PO: State: Zip Code; Soit Wales ph 14/39 1. Does the proposed action only involve the legislative adoption of a plan, local law, 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 may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? NO | YES If Yes, list agency(s) name and permit or approval: V4 3.a. Total acreage of the site of the proposed action? 0.046") _ acres b. Total acreage to be physically disturbed? 20 acres c. Total acreage (project site and any contiguous properties) owned + or controlled by the applicant or project sponsor? 2 BO’ acres 4. Check all land uses that occur on, adjoining and near the proposed action. O Urban Rural (non-agriculture) © Industrial Commercial 0 Residential (suburban) OForest 0 Agriculture C1 Aquatic C1 Other (specify): O Parkland Page 1 of 4