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moo, tA ._•T°T"` G KITTITAS COUNTY COMMUNITY <br />9 <br />crrrrrns u,usn <br />-- `Building Partnerships — Building Communities" <br />DEVELOPMENT SERVICES <br />411 N. Ruby St., Suite 2, Ellensburg, WA 98926 <br />CDS@CO.KITTITAS. WA. US <br />Office (509) 962-7506 <br />Fax (509) 962-7682 <br />SEPA ENVIRONMENTAL CHECKLIST <br />Purpose of checklist: <br />Governmental agencies use this checklist to help determine whether the environmental impacts of your proposal are <br />significant. This information is also helpful to determine if available avoidance, minimization or compensatory mitigation measures <br />will address the probable significant impacts or if an environmental impact statement will be prepared to further analyze the <br />proposal. <br />Instructions for applicants: <br />This environmental checklist asks you to describe some basic information about your proposal. Please answer each <br />question accurately and carefully, to the best of your knowledge. You may need to consult with an agency specialist or private <br />consultant for some questions. You may use "not applicable" or "does not apply" only when you can explain why it does not aoDly <br />and not when the answer is unknown. You may also attach or incorporate by reference additional studies reports. Complete and <br />accurate answers to these questions often avoid delays with the SEPA process as well as later in the decision-making process. <br />The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on <br />different parcels of land. Attach any additional information that will help describe your proposal or its environmental effects. The <br />agency to which you submit this checklist may ask you to explain your answers or provide additional information reasonably <br />related to determining if there may be significant adverse impact. <br />Instructions for Lead Aaencies: <br />Additional information may be necessary to evaluate the existing environment, all interrelated aspects of the proposal and an <br />analysis of adverse impacts. The checklist is considered the first but not necessarily the only source of information needed to <br />make an adequate threshold determination. Once a threshold determination is made, the lead agency is responsible for the <br />completeness and accuracy of the checklist and other supporting documents. <br />Use of checklist for non -project proposals: <br />For non -project proposals (such as ordinances, regulations, plans and programs), complete the applicable parts of <br />sections A and B plus the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D). Please completely answer all questions that <br />apply and note that the words "project," "applicant," and "property or site" should be read as "proposal," "proponent," and <br />"affected geographic area," respectively. The lead agency may exclude (for non -projects) questions in Part B - Environmental <br />Elements —that do not contribute meaningfully to the analysis of the proposal. <br />$600.00 Kittitas County Community Development Services (KCCDS) <br />$70.00 Kittitas County Department of Public Works <br />$670.00 Total fees due for this application (One check made payable to KCCDS) <br />Application Received by (CDS <br />FOR STAFF USE ONLY <br />DATE: <br />}� <br />RECEIPT# <br />1 <br />DATE STAMP IN <br />COMMUNITY PLANNING • BUILDING INSPECTION • PLAN REVIEW • ADMINISTRATION • PERMIT SERVICES • CODE ENFORCEMENT <br />FORM LAST REVISED: 12.30.15 <br />Pagel of 11 <br />