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Short Environmental Assessment Form Part I - Project Information 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 HluPe CCrALuSS © Name of Action or Project: USE ~ WtRiANLE an 4 oe Bp ers 7 AtokA 4 Hos2- Brief Description of Proposed Action: 6&e Yauecte Az we THE = ADINAAAt Regent, A TWEE of SAReUuNGS fllowED> Name of Applicant or Sponsor: Telephone: Wee Wo . PHO fj 4 le | a ewan RPHILZ © Foee Alu? (elf2cese Address: zc Geteot. Po CO - Aue RA aa Ua Zip A, Sh 1. Does EAs croposed 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. Ifno, continue to question 2. [| 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: C1 3. a. Total acreage of the site of the proposed action? Al # acres b. Total acreage to be physically disturbed? . © acres c. Total acreage (project site and any contiguous properties) owned . or controlled by the applicant or project sponsor? 3% acres 4. Check all land uses that occur on, are adjoining or near the proposed action: [_] Urban O Rural (non-agriculture) [J Industrial L Commercial [33 Residential (suburban) [I Forest ’ Agriculture [] Aquatic [-] Other(Specify): [] Parkland Page | of 3 SEAF 2019