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Short Environmental Assessment Form Part I - Project Information Instructions for Completing Part | — 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 | based on information currenUy available. If addilional 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: Dos, War * gracmeng panos) Project Location (describe, and attach a location maj): SSB BsteYo (RAL Brief Description of Proposed Action: 9, gaooraig & sto), Name of Applicant or Sponsor: Telephone} ify _ (yg S2-FO2 Y Reha. Address: Au mM ais how E-Mail: lacey lermunshamap leaun’ | ese Pa reloads Ra. City/PO: State: Zip Code: Foss Aucoank wy jJosa 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, administrative rule, or regulation? NO YES 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. a LJ 2. Does the proposed action require a permit, approval or funding from any other government Agency? NO VES If Yes, list agency(s) name and permil or approval: ; 7 TK Bier, pedir?AS ohesaze t] [v] 3. a. Total acreage of the site of the proposed action? erie , acres y b. Total acreage to be physically disturbed? ore acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? q AG acres 4, Check all Jand uses that occur on, are adjoining or near the proposed action: []Urban [7] Rural (non-agriculture) [1 Industrial bef Commercial [7] Residential (suburban) [7] Forest [[] Agriculture [] Aquatic [CJ Other(Specify): [~] Parkland Paps PoP 3 SEAF 2019