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KITTITAS COUNTY COMMUNITY DEVELOPMENT SERVICES <br />,#411 N.Ruby St.,Suite 2,Ellensburg,WA 98926 <br />CDS@CO.KITTITAS.WA.US <br />Office (509) 962-7506 <br />"Building Partnerships -Building Communities"Fax (509)962-7682 <br />SEPA ENVIRONMENTAL CHECKLIST <br />Purpose of checklist: <br />Governmental agencies use this checklist to help determinewhether the environmental impacts of your proposal are <br />significant.This information is also helpful to determine if available avoidance,minimization or compensatory <br />mitigation measures will address the probablesignificant impacts or if an environmental impact statement will be <br />prepared to further analyze the proposal. <br />Instructions for applicants: <br />This environmental checklist asks you to describe some basic informationabout 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 <br />or private consultant for some questions. You may use "not applicable"or "does not apply" only when you can <br />explain why it does not apply and not when the answer is unknown.You may also attach or incorporate by <br />referenceadditional studies reports.Complete and accurate answers to these questions often avoid delays with the <br />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 <br />effects.The agency to which you submit this checklist may ask you to explain your answers or provideadditional <br />informationreasonably related to determining if there may be significantadverse impact. <br />Instructions for Lead Agencies: <br />Please adjust the format of this template as needed.Additional information may be necessary to evaluate the <br />existing environment,all interrelated aspects of the proposal and an analysis of adverse impacts.The checklist is <br />considered the first but not necessarily the only source of information needed to make an adequatethreshold <br />determination. Once a threshold determination is made, the lead agency is responsible for the completeness and <br />accuracy of the checklist and other supporting documents. <br />Use of checklist for nonproject proposals:thelD1 <br />For nonproject proposals (such as ordinances,regulations,plans and programs),complete the applicable parts of <br />sections A and B plus the SUPPLEMENTALSHEET FOR NONPROJECT ACTIONs (part D).Please completely answer all <br />questions that apply and note that the words "project,""applicant,"and "property or site" should be read as <br />"proposal,""proponent,"and "affectedgeographic area,"respectively.The lead agency may exclude (for non- <br />projects)questions in Part B -Environmental Elements -that do not contribute meaningfully to the analysis of the <br />proposal. <br />APPI ICATION FFES: <br />$600.00 Kittitas County Community Development Services (KCCDS) <br />$250.00 Kittitas County Department of Public Works <br />$415.00 Kittitas County Public Health <br />$1,265.00 Total fees due for this application (One check made payable to KCCDS) <br />FOR STAFF USE ONLY <br />Application Received by (CDS Staff Signature):DATE:RECElPT# <br />DATE STAMP IN BOX <br />COMMUNITY PLANNING•BUILDING INSPECTION•PLAN REVIEW •ADMINISTRATION•PERMIT SERVICES•CODE ENFORCEMENT <br />FORM LAST REVISED:05-21-2018 <br />Page 1 of 13 Index #8