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Short Environmental Assessment Form Part 1 - 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 Name of Action or Project: mriance + keep SRO as js. Project Location (describe, and attach a lo¢ation map): 305 Fewet Holmen ( See swiVeg attaches ) Brief "Sp beep no. 6 In e¢J ( LIM eno SHtarte re ) as 5. (AoW ng, plecLument ond Vervisce pry Nobe:, TS oped was arobed KY original dwnes 33 yLys Re 4 We Lousy +e pr opp in Otfoher of 2016. Nameof Applicant or Sponsor: _ Telephone: aie 407 I-71 | | 7 (y-259 ay ah . a 4 tI | C - : =a SAN a) hrisnn’ “ey Tames = UV ev E Mail oh osciesk ole Jah oo “win eSs: 3905 Yewett Holmivood NO City/BA: tate Zip Code: 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, 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: here 3.a. Total acreage of the site of the proposed action? Th AY acres b. Total acreage to be physically disturbed? a acres c. Total acreage (project site and any contiguous properties) owned ~ or controlled by the applicant or project sponsor? ; 0) acres 4. Check all land uses that occur on, adjoining and near the proposed action. [[] Urban [Rural (non-agriculture) [[] Industrial [[]Commercial [jResidential (suburban) [lForest ElAgriculture [JAquatic [Other (specify): [JParkland Page 1 of 3