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PART ELEVEN-FORMS <br /> WAC 197-11-96D Environmental checklist. <br /> ENVIRONMENTAL CHECKLIST <br /> Purpose of checklist: <br /> The State Environmental Policy Act (SEPA), chapter 43.21C RCW, requires all governmental <br /> agencies to consider the environmental impacts of a proposal before making decisions. An environmental <br /> impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the <br /> quality of the environment. The purpose of this checklist is to provide information to help you and the agency <br /> identify impacts from your proposal(and to reduce or avoid impacts from the proposal, if it can be done)and to <br /> help the agency decide whether an EIS is required. <br /> Instructions for applicants: <br /> This environmental checklist asks you to describe some basic information about your proposal. <br /> Governmental agencies use this checklist to determine whether the environmental impacts of your proposal are <br /> significant, requiring preparation of an EIS. Answer the questions briefly, with the most precise information <br /> known,or give the best description you can. <br /> You must answer each question accurately and carefully,to the best of your knowledge. In most cases, <br /> you should be able to answer the questions from your own observations or project plans without the need to hire <br /> experts. If you really do not know the answer, or if a question does not apply to your proposal, write "do not <br /> know"or"does not apply." Complete answers to the questions now may avoid unnecessary delays later. <br /> Some questions ask about governmental regulations, such as zoning, shoreline, and landmark <br /> designations. Answer these questions if you can. If you have problems,the governmental agencies can assist <br /> you. <br /> The checklist questions apply to all parts of your proposal,even if you plan to do them over a period of <br /> time or on different parcels of land. Attach any additional information that will help describe your proposal or <br /> its environmental effects. The agency to which you submit this checklist may ask you to explain your answers <br /> or provide additional information reasonably related to determining if there may be significant adverse impact. <br /> Use of checklist for nonproject proposals: <br /> Complete this checklist for nonproject proposals, even though questions may be answered "does not <br /> apply." IN ADDITION,complete the SUPPLEMENTAL SHEET FOR NONPRO.ECT ACTIONS(part D). <br /> For nonproject actions, the references in the checklist to the words "project," "applicant," and <br /> "property or site"should be read as"proposal," "proposer,"and"affected geographic area,"respectively. <br /> A. BACKGROUND <br /> 1. Name of proposed project,if applicable: N/A <br /> 2. Name of applicant: David Jolly <br /> 3. Address and phone number of applicant and contact person: <br /> Applicant: Property Owner: Engineer: <br /> David Jolly David Jolly Schemmer Engineering <br /> 9800 Harbour Place 9800 Harbour Place 317 Commercial Avenue <br /> Mukilteo,WA. Mukilteo,WA. Suite 101 <br /> 98275 98275 Anacotres,WA. <br /> 98221 <br /> 4. Date checklist prepared: 1/16/06 <br /> 5. Agency requesting checklist: City of Anacortes <br /> 6. Proposed timing or schedule(including phasing,if applicable): <br />