Text · page 5 of 11
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
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, anc may be subject to further verification. Complete Part 1 based on
information currently available. 1f 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 m 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 ony item.
Part 1 — Project and Sponsor information
Name of Action or Project:
Dos, woe * GREEK Aa NoTSIT
Project Location (describe. and attach a location map):
SSP Botedo RA
I Brief Deser iption of Proposed Action:
Rapes PoS.2_ ware tare the
CAN, g ASIDE ©
Name of Applicant or Sponsor: Telephones Ff (y _ (92, 462 y
Address:
< Se Re orn 6 Pa
City/PO: State; Zip Code:
1.
Eos Aucoar BY
Does the proposed action only involve the legislative adoption of a plan, local law, ordinance,
[oso
NO YES
adiministrative rule, or repulation? aa
if Yes, atlach a narrative description of the intent of the proposed action and the environmental resources that
nay be affected in the municipality and proceed to Part 2. If no, continue to question 2, LI
2. Does the proposed action require a permit, approval or funding from any other government Agency? YES
If Yes, list agency(s) name and permit or approval: . —
TOA Bll Pesidurr,. AS Alole-raza LJ
3. a. Total acreage of the site of the proposed action? (5 acres 7
b. Total acreage to be physically disturbed? OS acres
¢, Total acreage (project site and any conliguous properties) owned
or controlled by the applicant or project sponsor? 3 AA Acres
4. Check all land uses that occur on. are adjoining or near the proposed action:
[} Urban [] Rural (non-agriculture) [] Industrial pe Commercial [[] Residential (suburban)
[J Forest [[] Agriculture [_] Aquatic {£4 Other(Specify):
[_] Parkland
Paps | oF 3 SEAF 2019