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ÐÑéWÑâ âÑ,°ÑÑÂÏÑâ âÑ  ÑÓ  Óà @ àò òÔ‡X°èXXX„=ÔLAKE€RESTORATION€FEASIBILITY€ASSESSMENTó óÐ , ÐÓÓÌÌLakes,€ponds€or€reservoirs€with€public€access€may€be€planted€with€Ô_Ô¢triploid£Ô_Ô€grass€carp€ifÏa€professional€lake€restoration€feasibility€assessment€has€been€completed€thatÏaddresses€all€of€the€following.ÌÌÓL€ .g(#LÓÝ ‚³´ ÝÝ  ÝÝ‚³´àÝÔ2gÔ(Ú  Ú1Ú  Ú)Ô3  Ôà0  àÝ  ÝCultural€Assessment݃³´à ÝŒÐ|P(#(# ÐŒÝ  ÝÌà  à(a.)à0 ` àCollection€of€historical€and€background€data€including€lake€description,Ð H   Ðwatershed€description€and€public€access€benefits.Ð ` (#` (# Ðà  à(b.)à0 ` àRecreational€use€and€pollutant€sources.Ð è ` (#` (# ÐÌÝ ‚³´ ÝÝ  ÝÝ‚³´àÝÔ2gÔ(Ú  Ú2Ú  Ú)Ô3  Ôà0  àÝ  ÝWater€Quality€Assessment݃³´à ÝŒÐà ´ (#(# ÐŒÝ  ÝÌà  à(a.)à0 ` àAquatic€plant€survey€(biomass€by€species€and€water€temperature€cycle).Ь€ ` (#` (# Ðà  à(b.)à0 ` àNutrient€budget.Ð’f` (#` (# Ðà  à(c.)à0 ` àHydraulic€budget.ÐxL` (#` (# Ðà  à(d.)à0 ` àNutrient€limitation.Ð^2` (#` (# Ðà  à(e.)à0 ` àBiological€relationships.ÐD` (#` (# Ðà  à(f.)à0 ` àLake€response€(cause€and€effect€relationships€between€nutrients€and€theÐ *þ Ðplant€and€animal€communities).Ð ` (#` (# ÐÌÝ ‚³´ ÝÝ  ÝÝ‚³´*ÝÔ2gÔ(Ú  Ú3Ú  Ú)Ô3  Ôà0  àÝ  ÝRestoration€Feasibility݃³´*UÝŒÐÜ°(#(# ÐŒÝ  ÝÌà  à(a.)à0 ` àEvaluate€potential€lake€restoration€techniques.Ш|` (#` (# Ðà  à(b.)à0 ` àDevelop€matrix€for€alternatives.ÐŽb` (#` (# Ðà  à(c.)à0 ` àIdentify€restoration€plan.ÐtH` (#` (# ÐÌÝ ‚³´ ÝÝ  ÝÝ‚³´%ÝÔ2gÔ(Ú  Ú4Ú  Ú)Ô3  Ôà0  àÝ  ÝPublic€Involvement݃³´%PÝŒÐ@(#(# ÐŒÝ  ÝÌà  à(a.)à0 ` àPublic€meetings€on€restoration€plan.Ð à` (#` (# ÐÌÝ ‚³´ ÝÝ  ÝÝ‚³´`ÝÔ2gÔ(Ú  Ú5Ú  Ú)Ô3  Ôà0  àÝ  ÝThe€results€of€C€(1)€through€(4)€must€be€presented€to€the€Department€of€Fish€andРج! ÐWildlife€in€the€form€of€a€single€report€by€the€project€proponent.€€A€permit€to€plantÏÔ_Ô¢triploid£Ô_Ô€grass€carp€will€be€issued€by€the€Department€of€Fish€and€Wildlife€if€theÏplan€identifies€Ô_Ô¢triploid£Ô_Ô€grass€carp€as€a€solution€to€the€waterððs€problems,€if€there€isÏpublic€support€and€if€there€is€a€written€plan€to€monitor€the€effectiveness€of€thisÏintroduction.Ô#†X„=XXX°è9#Ô݃³´`‹݌РV#*"&(#(# ÐÑœdOÑâ œâÑ°ÂÑÑ°,Ñâ œâÑ  ÑŒÝ  ÝÑ€Q<]Ñßp€O©<,(`~0ÕòÈÏ `ÀââEíÈÏÏ¢}¦epßâ °¢°¢°(#°(#âÌâ °¢°¢°¢°¢âÌâ °¢°¢°¢°¢âÌâ °¢°¢°¢°¢âà  àÌâ °¢°¢°¢°¢âÌâ °(#°(#°¢°¢âÔ‡X°èXXX„=ÔÓ  ÓState€of€WashingtonÐ L œ ÐÔ‡¼Y »XX°èÔDEPARTMENT€OF€FISH€AND€WILDLIFEÔ#†X°èX»¼Y .#ÔÐ 2 ‚ ÐÔ‡ô»óõXX°èÔMailing€Address:€600€Capitol€Way€N.,€Olympia,€WA€98501€(360)902„2200;€Ô_Ô¢TDD£Ô_Ô€(360)€902„2207Ô#†X°èXõô»ó¤#ÔÐ @  ÐÔ‡ô»óõXX°èÔMain€Office€Location:€Natural€Resource€Building,€1111€Washington€Street€SE,€Olympia,€WAÔ#†X°èXõô»óu#ÔÐ  R ÐÓúÓÌò òÔ‡ô»óõXX°èÔÔ_Ô¢Triploid£Ô_Ô€grass€carp€may€be€planted€in€the€stat€of€Washington€after€the€required€permits€andÐ ª ú  Ðdocuments€are€approved.€€These€permits€and€documents€include:ó óÐ r  ÐÌØØÓL€ ¤((.LÓÝ ‚³´ ÝÝ  ÝÝ‚³´© ÝÔ2¤ÔÚ  Ú1Ú  Ú.Ô3  Ôà0  àÝ  ÝDocumentation€from€the€United€States€Fish€and€Wildlife€Service€verifying€the€fish€being€plantedÐ üL  Ðare€certified€disease€free€Ô_Ô¢triploid£Ô_Ô€grass€carp.€€You€will€receive€this€from€the€vendor€distributingÏthe€fish.݃³´© Ô ÝŒÐ (#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´l"ÝÔ2¤ÔÚ  Ú2Ú  Ú.Ô3  Ôà0  àÝ  ÝAn€application€to€plant€Ô_Ô¢triploid£Ô_Ô€grass€carp€from€the€Department€of€Fish€and€Wildlife€(enclosed).݃³´l"—"ÝŒÐT(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´¶#ÝÔ2¤ÔÚ  Ú3Ú  Ú.Ô3  Ôà0  àÝ  ÝAn€Environmental€Checklist€(enclosed).݃³´¶#á#݌ЈØ(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´¤$ÝÔ2¤ÔÚ  Ú4Ú  Ú.Ô3  Ôà0  àÝ  ÝHydraulic€Project€Approval€(ONLY€if€screening€is€required)€(enclosed).݃³´¤$Ï$݌Р\(#(# ÐŒÝ  ÝÌò òThe€enclosed€materials€are€needed€to€apply€for€a€permit€to€plant€Ô_Ô¢triploid£Ô_Ô€grass€carp.€€PleaseÐ à Ðfollow€the€instructions€below€to€ensure€your€application€will€be€processed€quickly.ó óÐ X¨ ÐÌØØÓL€ "Eh((LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ 'ÝÔ2EhÔÚ  Ú1Ú  Ú.Ô3  Ôà0  àÝ  ÝComplete€the€application€for€planting€Ô_Ô¢triploid£Ô_Ô€grass€carp.€€Follow€all€instructions€and€provideÐ â2 Ðaccurate€answers€for€each€question.݃³´ 'K'݌Р(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´™(ÝÔ2EhÔÚ  Ú2Ú  Ú.Ô3  Ôà0  àÝ  ÝStudy€the€guide€ð ðHow€Many€Grass€Carp€Need€to€Be€Planted?ðð€to€help€you€in€drawing€a€picture€ofÐ (x Ðyour€lake€or€pond€and€its€associated€vegetation.݃³´™(Ä(݌Р(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´*ÝÔ2EhÔÚ  Ú3Ú  Ú.Ô3  Ôà0  àÝ  ÝIf€your€lake€or€pond€is€public,€the€results€of€a€lake€restoration€study€must€be€provided€to€theÐ n¾  ÐDepartment€of€Fish€and€Wildlife€in€place€of€the€drawing€listed€in€Item€2.€€The€enclosedÏð ðStandards€for€Lake€Restoration€Studyðð€must€be€met.݃³´*,*݌Р(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´Æ+ÝÔ2EhÔÚ  Ú4Ú  Ú.Ô3  Ôà0  àÝ  ÝPlease€complete€the€ð ðEnvironmental€Checklistðð€to€the€best€of€your€ability.€€We€have€provided€youÐ v!Æ$ Ðwith€information€for€several€sections€on€the€list.݃³´Æ+ñ+݌Р(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´3-ÝÔ2EhÔÚ  Ú5Ú  Ú.Ô3  Ôà0  àÝ  ÝIf€the€body€of€water€to€be€planted€with€grass€carp€flows€into€another€body€of€water,€it€will€have€toÐ ¼# ' Ðbe€screened.€€You€will€need€to€complete€the€enclosed€Hydraulic€Project€Application€to€obtain€aÏHydraulic€Project€Approval€(Ô_Ô¢HPA£Ô_Ô)€before€installing€the€screen.€€Criteria€for€the€screen(s)€will€beÏspecified€in€the€Ô_Ô¢HPA£Ô_Ô.€€We€suggest€the€screen€mesh€should€be€no€greater€than€1€Ô_Ô¢1£Ô_Ô/4"€and€theÏscreen€should€extend€at€least€three€feet€above€the€water.€€However,€this€design€may€be€differentÏdepending€upon€the€size€of€water€to€be€screened.݃³´3-^-݌Р(#(# ÐŒÝ  ÝÌPlease€send€all€documents€and€a€$24€check€(made€out€to€the€Washington€Department€of€Fish€andÏWildlife)€to€the€Departmentððs€ò òregional€officeó ó€which€has€jurisdiction€in€the€county€of€your€lake€or€pond.€Ð Ì)%/ ÐThere€is€a€list€of€addresses€and€telephone€numbers€for€each€regional€office€enclosed.€€Your€applicationÏmay€take€approximately€six€to€eight€weeks€to€process.€€If€your€permit€is€not€approved,€the€$24€fee€will€beÏreturned€to€you.€€If€you€have€any€questions,€please€contact€the€same€regional€office€where€you€submittedÏyour€application.Ô#†X°èXõô»ó7#ÔÐ Ú,*(3 ÐÓ  ÓÐ œ-ì(4 ÐÑQ<]Ñâ QâÑ °ÑÑî°Ñâ QâÑ  Ñà @ àò òWASHINGTON€DEPARTMENT€OF€FISH€AND€WILDLIFEÐ   ÐApplication€for€Planting€Ô_Ô¢Triploid£Ô_Ô€Grass€Carpó óÐ ùì ÐÓé2ÓÌØØÓL€ R•h(("LÓÝ ‚³´ ÝÝ  ÝÝ‚³´‹4ÝÔ2•hÔÚ  Ú1Ú  Ú.Ô3  Ôà0  àÝ  ÝÔ‡&tP%XX°èÔName€of€Applicant€or€Organization:€___________________________à x àà Ð àà @Ð àà @Ð àà @Ð à݃³´‹4¶4ÝŒÐ˾(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´ì5ÝÔ2•hÔÚ  Ú2Ú  Ú.Ô3  Ôà0  àÝ  ÝAddress:€_____________________________€€€3.€€Day€Phone:€___________݃³´ì56݌Ѕx(#(# ÐŒÝ  ÝÌØØÓL€ ºµh((RLÓÝ ‚³´ ÝÝ  ÝÝ‚³´b7ÝÔ2µhÔÚ  Ú4Ú  Ú.Ô3  Ôà0  àÝ  ÝName€of€Lake€or€Pond€to€be€Planted:€___________________________݃³´b77ÝŒÐ- (#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´i8ÝÔ2µhÔÚ  Ú5Ú  Ú.Ô3  Ôà0  àÝ  ÝCounty:€€à ¸ à_________€€€€€€Township:€_______Ô#†X°èX%&tP5#ÔÔ‡&tP%XX°èÔ€€€Range:Ô#†X°èX%&tPE9#ÔÔ‡&tP%XX°èÔ€______à0x(#(#à€€€€€Section:Ô#†X°èX%&tP9#ÔÔ‡&tP%XX°èÔÐ Õ È  Ð______݃³´i8”8݌Рx(#x(# ÐŒÝ  ÝÌò òNote:€A€photocopy€of€a€county€map€showing€rivers€and€streams€at€the€proposed€plantingÐ Q D  Ðlocation€MUST€be€provided€with€this€application.ó óÐ -  ÐÌÝ ‚³´ ÝÝ  ÝÝ‚³´&;ÝÔ2µhÔÚ  Ú6Ú  Ú.Ô3  Ôà0  àÝ  ÝSize€of€lake€or€pond€(1€acre=€208€ft.€x€208€ft):€Ô#†X°èX%&tPú9#ÔÔ‡&tP%XX°èÔ_______€€€Max€Depth€(ft):Ô#†X°èX%&tPþ;#ÔÔ‡&tP%XX°èÔ€______݃³´&;Q;ÝŒÐÝÐ (#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´Ã<ÝÔ2µhÔÚ  Ú7Ú  Ú.Ô3  Ôà0  àÝ  ÝDoes€this€pond€or€lake€have€public€access€provided€by€the€city,€county,€state€or€federalÐ …x Ðgovernment€or€other€publicly€owned€municipality?€€YES€_____Ô#†X°èX%&tPY<#ÔÔ‡&tP%XX°èÔà  à€€NO€____Ô#†X°èX%&tP>#Ôà Ð à݃³´Ã<î<ÝŒÐYL(#(# ÐŒÝ  ÝÔ‡&tP%XX°èÔÌ(Answer€ð ðNOðð€for€golf€course,€sewage€treatment€or€fish€culture€ponds€and€power€or€irrigationÏcanals).ÌòòIf€you€answered€ð ðNOðð,€got€to€No.€9.óóÐ ©œ ÐÌÝ ‚³´ ÝÝ  ÝÝ‚³´‰?ÝÔ2µhÔÚ  Ú8Ú  Ú.Ô3  Ôà0  àÝ  ÝIf€you€answered€ð ðYESðð€to€number€7,€are€the€results€of€a€Lake€Restoration€FeasibilityÐ QD ÐStudy€included?€€YES€_____€€€€NO€_____à  àà p àà È à݃³´‰?´?ÝŒÐ%(#(# ÐŒÝ  ÝÌà  àIf€you€answered€ð ðYESðð,€go€to€No.€11€and€skip€No.€12.Ìà  àIf€you€answered€ð ðNOðð,€a€permit€cannot€be€issued.ÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´•AÝÔ2µhÔÚ  Ú9Ú  Ú.Ô3  Ôà0  àÝ  ÝTotal€number€of€waterfront€property€owners:€____________à  àà x à݃³´•AÀAÝŒÐI<(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´­BÝÔ2µhÔÚ  Ú10Ú  Ú.Ô3  Ôà0  àÝ  ÝNumber€of€waterfront€property€owners€that€support€______€€or€oppose€_____€€€€€€Ð ñä  Ðproposed€planting€of€Ô_Ô¢triploid£Ô_Ô€grass€carp.݃³´­BØB݌Р(#(# ÐŒÝ  ÝÌòòNOTE:óóà0 ` àThe€names,€addresses€and€phone€numbers€of€all€waterfront€property€ownersÐ m`# Ðand€whether€or€not€they€support€the€proposed€grass€carp€introduction€MUST€beÏprovided€with€this€application.Ð ` (#` (# Ðà  àà ` àà ¸ àÌÝ ‚³´ ÝÝ  ÝÝ‚³´9EÝÔ2µhÔÚ  Ú11Ú  Ú.Ô3  Ôà0  àÝ  ÝHave€all€outlets€and/or€inlets€been€screened?:€YES€______€€NO€_____€€€€€€€€€€€Ýƒ³´9EdE݌н"° '(#(# ÐŒÝ  Ýà0  àIf€you€answered€ð ðNOðð,€you€must€complete€the€enclosed€Hydraulic€Project€ApplicationÏbefore€installing€screens.€€òòThe€Department€of€Fish€and€Wildlife€will€not€issued€a€permitÐ e$X") Ðto€plant€Ô_Ô¢triploid£Ô_Ô€grass€carp€into€waters€with€unscreened€outlets.óó€€If€the€proposed€lake€orÐ 9%,#* Ðpond€is€greater€than€20€acres,€other€permits€from€the€county€may€be€required€to€installÏscreens.Ð (#(# ÐÌÝ ‚³´ ÝÝ  Ýߤ€«êp2`\ j~0ð û'pppÀKK@@@ÿ ¢ KKE *ppppU½)¤ßÝ‚³´0HÝÔ2µhÔÚ  Ú12Ú  Ú.Ô3  Ôà0  àÝ  ÝPlease€draw€a€map€of€the€lake€or€pond€as€close€to€scale€as€possible€on€the€attachedÐ ‰(|&. Ðsheet.€€Draw€in€vegetation€types€that€are€present€as€described€in€the€attached€guideÏð ðHow€Many€Grass€Carp€to€Plant?ðð€€This€map€will€assist€our€biologists€in€determining€howÏmany€fish€to€plant€into€your€pond€or€lake.݃³´0HÿH݌Р(#(# ÐŒÝ  ÝÌ_______________________________à0 À àà0À(#À(#à____________________________Э, *3(#(# ÐSignature€of€Applicantà0  àà0h(#(#àà0Àh(#h(#àDateÐ-t+4À(#À(# Ðà  àà ` àà ¸ àà  àà h àà À àà  àà p àà È àà  àà x àÐ  U.H,5 ÐѦJÑâ ¦âÑÏîÑÑ„ Ñâ ¦âÑ  Ñò òÓ  ÓÑ€ïhÑMAP€OF€LAKE€OR€PONDó óÐ „ ÐÓ°LÓÌPlease€include€distribution€of€each€vegetation€type.€€Irrigation€and€power€canal€applicants€needÏonly€proved€estimated€acres€of€each€plant€type.ÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌName€of€Applicant:€_________________________________ÌName€of€Lake€or€Pond:€______________________________ÌÌÌÐ œ.+4 Ðâ °°°(#°(#âÑïhÑâ âÑîÏÑâ âÑ  Ñà  àà ` àà ¸ àà  àà h àÌâ °°°°âÌâ °°°°âÌâ °°°°âßr€O»>'.*`~0òùéí` à3@EQùéíéí®ƒrßâ °°°°âÌâ °°°°âÓ  ÓÌâ °°°°âÌâ °(#°(#°°âState€of€WashingtonÌò òDEPARTMENT€OF€FISH€AND€WILDLIFEó óÐ P Ì ÐÔ#†X°èX%&tP¸>#Ôԇ«x ÂXX°èÔHabitat€Program:€600€Capitol€Way€N.,€Olympia€Washington€98501„1091€„€(360)€902„2534Ô#†X°èX «x•P#ÔÔ‡&tP%XX°èÔÐ , ¨ ÐÓ  ÓÌò òÓ  ÓENVIRONMENTAL€CHECKLISTÐ ª &  Ð(WAC€197„11„960)ó óÐ †   ÐÓ  ÓÌØ ØÓL€ É*ù((ºLÓÝ ‚³´ ÝÝ  ÝÝ‚³´FRÝÔ2*ùÔÚ  ÚAÚ  Ú.Ô3  Ôà0  àÝ  ÝBACKGROUND݃³´FRqRÝŒÐ6² (#(# ÐŒÝ  ÝÌØØÓL€ å£((ÉLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ƒSÝÔ2å£ÔÚ  Ú1Ú  Ú.Ô3  Ôà0  àÝ  ÝName€of€proposed€project€if€applicable:݃³´ƒS®SÝŒÐÞZ (#(# ÐŒÝ  ÝÌà  àà ` àòòò òPlant€Ô_Ô¢triploid£Ô_Ô€(sterile)€gras€carp€to€control€aquatic€vegetation.ó óóóÐ † ÐÌÝ ‚³´ ÝÝ  ÝÝ‚³´UÝÔ2å£ÔÚ  Ú2Ú  Ú.Ô3  Ôà0  àÝ  ÝName€of€applicant:݃³´U:UÝŒÐ6²(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´êUÝÔ2å£ÔÚ  Ú3Ú  Ú.Ô3  Ôà0  àÝ  ÝAddress€and€phone€number€of€applicant€and€contact€person:݃³´êUV݌в.(#(# ÐŒÝ  ÝÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´îVÝÔ2å£ÔÚ  Ú4Ú  Ú.Ô3  Ôà0  àÝ  ÝDate€of€checklist€prepared:݃³´îVWÝŒÐÖR(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´ÑWÝÔ2å£ÔÚ  Ú5Ú  Ú.Ô3  Ôà0  àÝ  ÝAgency€requesting€checklist:€€€€òòò òWashington€Department€of€Fish€and€Wildlifeó óóó݃³´ÑWüWÝŒÐ~ú(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´ïXÝÔ2å£ÔÚ  Ú6Ú  Ú.Ô3  Ôà0  àÝ  ÝProposed€timing€or€schedule€(include€phasing,€if€applicable):݃³´ïXYÝŒÐ*¦(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´öYÝÔ2å£ÔÚ  Ú7Ú  Ú.Ô3  Ôà0  àÝ  ÝDo€you€have€any€plans€for€future€additions,€expansions€or€further€activity€related€to€orÐ z ö# Ðconnected€with€this€proposal?€€If€yes,€explain:݃³´öY!Z݌Р(#(# ÐŒÝ  Ýñ'ñà  àñ'ññ(ñà0  àñ(ññ#ñò òñ#ññ$ñNOTñ$ññ%ññ$ñeñ$ññ%ññ&ñE:€€ñ&ñ(If€you€might€lose€fish€to€predation€and€ñ)ñmay€ñ)ñneed€to€reñ*ñplenish€ñ*ñstock,€this€shouldÐ ""ž% Ðbe€statedñ!ññ ñañ ññ!ññ"ñ)ñ"ññ#ñó óñ#ñÐþ"z&(#(# ÐÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´\ÝÔ2å£ÔÚ  Ú8Ú  Ú.Ô3  Ôà0  àÝ  ÝList€any€environmental€information€you€know€about€that€has€been€prepared€or€will€beÐ *'¦#+ Ðprepared,€directly€related€to€this€proposal:݃³´\¸\݌Р(#(# ÐŒÝ  ÝÌà0  àà0` (#(#àòòA€document€titled:€ð ðUse€of€Ô_Ô¢Triploid£Ô_Ô€Grass€Carp€in€Washington,ðð€prepared€byÐ ¦)"&. ÐWashington€Department€of€Fish€and€Wildlife.óóÐz*ö&/` (#` (# ÐÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´Û^ÝÔ2å£ÔÚ  Ú9Ú  Ú.Ô3  Ôà0  àÝ  ÝDo€you€know€whether€applications€are€pending€for€government€approvals€of€otherÐ Ê-F*3 Ðproposals€directly€affecting€the€property€covered€by€your€proposal?€€If€yes,€explain:݃³´Û^_݌Р(#(# ÐŒÝ  ÝÔ_ÔÐ r/î+5 Ðà  àà ` àòòNo.óóÐ „ ÐÌÝ ‚³´ ÝÝ  ÝÝ‚³´®`ÝÔ2å£ÔÚ  Ú10Ú  Ú.Ô3  Ôà0  àÝ  ÝList€any€government€approvals€or€permits€that€will€be€needed€for€your€proposal,€ifÐ ,¨ Ðknown:݃³´®`Ù`݌Р(#(# ÐŒÝ  ÝÝ ‚#Àd ÝÝ  ÝÝ‚#ÀdÛaÝà0  àà0` (#(#àÔ2å£ÔÚ  Ú1Ú  Ú.Ô3  Ôà0¸ ` (#` (#àÝ  ÝPlanting€permit€from€Washington€Department€of€Fish€and€Wildlife.݃#ÀdÛabÝŒÐÔP¸ (#¸ (# ÐŒÝ  ÝÝ ‚#Àd  ÝÝ  ÝÝ‚#Àd cÝà0  àà0` (#(#àÔ2å£ÔÚ  Ú2Ú  Ú.Ô3  Ôà0¸ ` (#` (#àÝ  ÝCertificate€from€U.S.€Fish€and€Wildlife€Service€that€the€fish€shipped€areÐ ¨$ ÐÔ_Ô¢triploids£Ô_Ô€(sterile)€and€certification€that€the€fish€show€no€sign€of€disease.݃#Àd c5c݌Р¸ (#¸ (# ÐŒÝ  ÝÌÝ ‚³´  ÝÝ  ÝÝ‚³´¾dÝÔ2å£ÔÚ  Ú11Ú  Ú.Ô3  Ôà0  àÝ  ÝGive€a€brief,€complete€description€of€your€proposal,€Ô_Ô¢inlcuding£Ô_Ô€the€prosed€used€and€theÐ $   Ðsize€of€the€project€and€size.€€There€are€several€questions€later€in€this€checklist€that€askÏyou€to€describe€certain€aspects€of€your€proposal.€€You€do€not€need€to€answer€those€onÏthis€page.݃³´¾déd݌Р(#(# ÐŒÝ  ÝÌà  àà ` àPlant€¢triploid£€grass€carp€to€control€aquatic€vegetation.ÌÌÌà  àÌÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´.gÝÔ2å£ÔÚ  Ú12Ú  Ú.Ô3  Ôà0  àÝ  ÝLocation€of€proposal.€€Give€sufficient€information€for€a€person€to€understand€the€preciseÐ èd Ðlocation€of€your€Ô_Ô¢prosposed£Ô_Ô€project,€including€street€address,€if€any,€and€section,Ïtownship€and€range,€if€known.€€If€a€proposal€would€occur€over€a€range€of€area,€provideÏthe€range€or€boundaries€of€the€site(s).€€Provide€a€legal€description,€site€plan,€vicinity€mapÏand€topographic€map,€if€reasonably€available.€€While€you€should€submit€any€plansÏrequired€by€the€agency,€you€are€not€required€to€duplicate€maps€or€detailed€plansÏsubmitted€with€any€permit€applications€related€to€this€checklist.݃³´.gYg݌Р(#(# ÐŒÝ  ÝÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌB.€€ENVIRONMENTAL€ELEMENTSÌÌØ ØÓL€ 2¤((LÓÝ ‚³´ ÝÝ  ÝÝ‚³´kÝÔ2¤ÔÚ  Ú1Ú  Ú.Ô3  Ôà0  àÝ  ÝEARTH݃³´k-kÝŒÐD+À'0(#(# ÐŒÝ  ÝÌØØÓL€ 3%¤((2LÓÝ ‚³´ ÝÝ  ÝÝ‚³´:lÝÔ2%¤ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝGeneral€description€of€the€site€(circle€one):€Flat,€rolling,€hilly,€steep€slopes,€mountainous,Ð ì,h)2 Ðother:€€€Ýƒ³´:lel݌Р(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´vmÝÔ2%¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€is€the€steepest€slope€on€the€site€(approximate€percent€slope)?݃³´vm¡mÝŒÐh/ä+5(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´‚nÝÔ2%¤ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€general€type€of€soils€are€found€on€the€site€(for€example:€clay,€sand,€gravel,€peat,Ð ,¨ Ðmuck)?€€If€you€know€the€classification€of€agricultural€soils,€specify€them€and€not€anyÏprime€farmland.݃³´‚n­n݌Р(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´pÝÔ2%¤ÔÚ  ÚdÚ  Ú.Ô3  Ôà0  àÝ  ÝAre€there€surface€indications€or€history€of€unstable€soils€in€the€immediate€vicinity?€€If€os,Ð P Ì Ðdescribe:݃³´pAp݌Р(#(# ÐŒÝ  ÝÌÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´UqÝÔ2%¤ÔÚ  ÚeÚ  Ú.Ô3  Ôà0  àÝ  ÝDescribe€the€purpose,€type€and€approximate€quantities€of€any€filling€or€gradingÐ ˜  Ðproposed.€€Indicate€source€of€fill.݃³´Uq€q݌Р(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´žrÝÔ2%¤ÔÚ  ÚfÚ  Ú.Ô3  Ôà0  àÝ  ÝCould€erosion€occur€as€a€result€of€clearing,€construction€or€use?€€If€so,€generallyÐ @¼ Ðdescribe:݃³´žrÉr݌Р(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ÐsÝÔ2%¤ÔÚ  ÚgÚ  Ú.Ô3  Ôà0  àÝ  ÝAbout€what€percent€of€the€site€will€be€covered€with€impervious€surfaces€after€projectÐ   Ðconstruction€(for€example:€asphalt€or€buildings)?݃³´Ðsûs݌Р(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´+uÝÔ2%¤ÔÚ  ÚhÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€erosion,€or€other€impacts€to€the€earth,€if€any:݃³´+uVu݌Рˆ(#(# ÐŒÝ  ÝÌÌÌØØÓL€ 45¤((3LÓÝ ‚³´ ÝÝ  ÝÝ‚³´¶vÝÔ25¤ÔÚ  Ú2Ú  Ú.Ô3  Ôà0  àÝ  ÝAIR݃³´¶vávÝŒÐ\Ø(#(# ÐŒÝ  ÝÌØØÓL€ 7E¤((4LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ìwÝÔ2E¤ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€type€of€emissions€to€the€air€would€result€from€the€proposal€(for€example:€dustÐ €  Ðautomobile,€odors,€industrial€wood€smoke)€during€construction€and€when€the€project€isÏcompleted?€€If€any,€generally€describe€and€give€approximate€quantities€if€known.݃³´ìwx݌Р(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´¼yÝÔ2E¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝAre€there€any€off„site€sources€of€emissions€or€odor€that€may€affect€your€proposal?€€If€so,Ð ü"x& Ðgenerally€describe:݃³´¼yçy݌Р(#(# ÐŒÝ  ÝÌÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´{ÝÔ2E¤ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€emissions€or€other€impacts€to€air,€if€any:݃³´{-{ÝŒÐÈ(D%-(#(# ÐŒÝ  ÝÌÌÌÌÌÌÌÐ h/ä+5 ЇÌØØÓL€ CU¤((7LÓÝ ‚³´ ÝÝ  ÝÝ‚³´£|ÝÔ2U¤ÔÚ  Ú3Ú  Ú.Ô3  Ôà0  àÝ  ÝWATER݃³´£|Î|ÝŒÐXÔ(#(# ÐŒÝ  ÝÓL€ Xbä (CLÓÝ ‚³´ ÝÝ  ÝÝ‚³´»}ÝÔ2bäÔÚ  ÚdÚ  Ú.Ô3  Ôà0  àÝ  ÝòòSurfaceóó݃³´»}æ}ÝŒÐ,¨(#(# ÐŒÝ  ÝÝ ‚ú» ÝÝ  ÝÝ‚ú»~Ýà0  àÔ2bäÔÚ  Ú1Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝIs€there€any€surface€water€body€on€the€immediate€vicinity€of€the€site€(includingÐ | Ðyear„round€and€season€streams,€saltwater,€lakes,€ponds€or€wetlands)?€€If€yes,Ïdescribe€type€and€provide€names.€€If€appropriate,€state€what€stream€or€river€itÏflows€into.݃ú»~º~݌Р` (#` (# ÐŒÝ  ÝÌÌÌÌÝ ‚ú» ÝÝ  ÝÝ‚ú»t€Ýà0  àÔ2bäÔÚ  Ú2Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝWill€the€project€require€any€work€over,€in€or€adjacent€to€(within€200€feet)€theÐ     Ðdescribed€waters?€€If€yes,€please€describe€and€attach€available€plans.݃ú»t€Ÿ€ÝŒÐ ` (#` (# ÐŒÝ  ÝÌÌÌÌÝ ‚ú» ÝÝ  ÝÝ‚ú»õÝà0  àÔ2bäÔÚ  Ú3Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝEstimate€the€amount€of€fill€and€dredge€material€that€would€be€placed€in€orÐ ˜ Ðremoved€from€surface€water€or€wetlands€and€indicate€the€area€of€the€site€thatÏwould€be€affected.€€Indicate€the€source€of€fill€material.݃ú»õ ‚݌Р` (#` (# ÐŒÝ  ÝÌÌÌÝ ‚ú» ÝÝ  ÝÝ‚ú»±ƒÝà0  àÔ2bäÔÚ  Ú4Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝWill€the€proposal€require€surface€water€withdrawals€or€diversions?€€Give€generalÐ   Ðdescription,€purpose€and€approximate€quantities€if€known.݃ú»±ƒÜƒÝŒÐ ` (#` (# ÐŒÝ  ÝÌÌÌÝ ‚ú» ÝÝ  ÝÝ‚ú»%…Ýà0  àÔ2bäÔÚ  Ú5Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝDoes€the€proposal€lie€within€a€100„year€Ô_Ô¢floodplain£Ô_Ô?€€€€YES€€€€€NO݃ú»%…P…݌д0` (#` (# ÐŒÝ  Ýà  àà ` àòòò òIf€so,€not€location€on€the€site€plan.ó óóóÐ ˆ ÐÌÌÝ ‚ú» ÝÝ  ÝÝ‚ú»Ã†Ýà0  àÔ2bäÔÚ  Ú6Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝDoes€the€proposal€involve€any€discharges€of€waste€material€to€surface€waters?€Ð  ˆ  ÐIf€so,€describe€the€type€of€waste€and€anticipated€volume€of€discharge.݃ú»Ã†î†ÝŒÐ ` (#` (# ÐŒÝ  ÝÌÌØØÓL€ G¤( XLÓÝ ‚³´ ÝÝ  ÝÝ‚³´¬ˆÝÔ2¤ÔÚ  Ú3Ú  Ú.Ô3  Ôà0  àÝ  ÝWATER݃³´¬ˆ×ˆÝŒÐ\!Ø$(#(# ÐŒÝ  ÝØØÓL€ Yu¤((GLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ã‰ÝÔ2u¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝòòGroundóó݃³´ã‰ŠÝŒÐ0"¬%(#(# ÐŒÝ  ÝÌÓL€ Z…¤((YLÓÝ ‚ú» ÝÝ  ÝÝ‚ú»‹Ýà0  àÔ2…¤ÔÚ  Ú1Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝWill€ground€water€be€withdrawn€or€will€water€be€discharged€to€ground€water?€Ð Ø#T ' ÐGive€general€description,€purpose€and€approximate€quantities,€if€known.݃ú»‹.‹ÝŒÐ ` (#` (# ÐŒÝ  Ýà  àÌÌÌÌÝ ‚ú» ÝÝ  ÝÝ‚ú»ŽŒÝà0  àÔ2…¤ÔÚ  Ú2Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝDescribe€waste€material€that€will€be€discharged€into€the€ground€from€septic€tanksÐ Ð(L%- Ðor€other€sources,€if€any€(for€example:€domestic€sewage,€industrial,€containing€theÏfollowing€chemicals€...,€agricultural).€€Describe€the€general€size€of€the€system,€theÏnumber€of€such€systems,€the€number€of€houses€to€be€served€(if€applicable)€orÏthe€number€of€animals€or€humans€the€system(s)€are€expected€to€serve.݃ú»ŽŒ¹ŒÝŒÐ ` (#` (# ÐŒÝ  ÝÌÌÌÐ p/ì+5 ЇØØÓL€ NE¤((ZLÓÝ ‚³´ ÝÝ  ÝÝ‚³´…ÝÔ2E¤ÔÚ  Ú3Ú  Ú.Ô3  Ôà0  àÝ  ÝWATER݃³´…°ÝŒÐ„(#(# ÐŒÝ  ÝØØÓL€ [’ä (NLÓÝ ‚³´ ÝÝ  ÝÝ‚³´¼ÝÔ2’äÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝWater€Runoff€(including€storm€water):݃³´¼çÝŒÐXÔ(#(# ÐŒÝ  ÝÌÝ ‚ú» ÝÝ  ÝÝ‚ú»©‘Ýà0  àÔ2’äÔÚ  Ú1Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝDescribe€the€source€of€runoff€(including€storm€water)€and€method€of€collectionÐ | Ðand€disposal,€if€any€(including€quantities,€if€known).€€Where€will€this€water€flow?€ÏWill€this€water€flow€into€other€waters?€€If€so,€describe.݃ú»©‘ԑ݌Р` (#` (# ÐŒÝ  ÝÌÌÌÌÝ ‚ú» ÝÝ  ÝÝ‚ú»q“Ýà0  àÔ2’äÔÚ  Ú2Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝCould€waste€materials€enter€ground€or€surface€waters?€€If€so,€generally€describe.݃ú»q“œ“ÝŒÐÌ H ` (#` (# ÐŒÝ  ÝÌÌÌØØÓL€ de¤( [LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ •ÝÔ2e¤ÔÚ  ÚdÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€surface,€ground€and€runoff€water€impacts,€ifÐ ˜  Ðany:݃³´ •6•ÝŒÐ (#(# ÐŒÝ  ÝÌÌÌÌÌØØÓL€ \¥¤((dLÓÝ ‚³´ ÝÝ  ÝÝ‚³´¦–ÝÔ2¥¤ÔÚ  Ú4Ú  Ú.Ô3  Ôà0  àÝ  ÝPLANTS݃³´¦–Ñ–ÝŒÐèd(#(# ÐŒÝ  ÝÌØØÓL€ cU¤((\LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ß—ÝÔ2U¤ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝCheck€or€circle€types€of€vegetation€found€on€the€site:݃³´ß— ˜ÝŒÐ (#(# ÐŒÝ  Ýà  àÌà  à___€€deciduous€tree:€alder,€maple,€aspen,€otherÌà  àà ` àÌà  à___€€evergreen€tree:€fir,€cedar,€pine,€otherÌÌà  à___€€shrubsÌÌà  à___€€grassÌÌà  à___€€pastureÌÌà  à___€€crop€or€grainÌÌà  à___€€wet€soil€plants:€cattail,€buttercup,€bulrush,€skunk€cabbage,€otherÌÌà  à___€€water€plants:€waterlily,€eelgrass,€milfoil,€otherÌà  àà ` àÌà  à___€€other€types€of€vegetation€ÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ÁšÝÔ2U¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€kind€and€amount€of€vegetation€will€be€removed€or€altered?݃³´ÁšìšÝŒÐ 'œ#+(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´É›ÝÔ2U¤ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝList€threatened€and€endangered€species€(of€plants)€known€to€be€on€or€near€the€site.݃³´É›ô›ÝŒÐp*ì&/(#(# ÐŒÝ  ÝÌÌÌÌÌÐ h/ä+5 ÐÝ ‚³´ ÝÝ  ÝÝ‚³´ýœÝÔ2U¤ÔÚ  ÚdÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€landscaping,€use€of€native€plants€or€other€measures€to€preserve€or€enhanceÐ „ Ðvegetation€on€the€site€if€any:݃³´ýœ(݌Р(#(# ÐŒÝ  ÝÌÌÌÌÓL€ eu¤((cLÓÝ ‚³´ ÝÝ  ÝÝ‚³´’žÝÔ2u¤ÔÚ  Ú5Ú  Ú.Ô3  Ôà0  àÝ  ÝANIMALS݃³´’ž½žÝŒÐ|ø(#(# ÐŒÝ  ÝØØÓL€ f…¤((eLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ËŸÝÔ2…¤ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝCircle€any€birds€or€animals€which€have€been€observed€on€or€near€the€site€or€are€knownÐ P Ì Ðto€be€on€or€near€the€site:݃³´ËŸöŸÝŒÐ (#(# ÐŒÝ  ÝÌà  àBirds:€hawk,€heron,€eagle,€songbirds,€other:€________________ÌÌà  àMammals:€deer,€bear,€elk,€beaver,€other:€______________ÌÌà  àFish:€bass,€salmon,€trout,€herring,€shellfish,€other:€_______________ÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ò¡ÝÔ2…¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝList€any€threatened€or€endangered€species€known€to€be€on€or€near€the€site.݃³´ò¡¢ÝŒÐÄ@ (#(# ÐŒÝ  ÝÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´£ÝÔ2…¤ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝIs€the€site€part€of€a€migration€route?€€If€so,€explain.݃³´£2£ÝŒÐèd(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´¤ÝÔ2…¤ÔÚ  ÚdÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€preserve€and€enhance€wildlife,€if€any:݃³´¤3¤ÝŒÐ8´(#(# ÐŒÝ  ÝÌÌÌØØÓL€ g•¤((fLÓÝ ‚³´ ÝÝ  ÝÝ‚³´x¥ÝÔ2•¤ÔÚ  Ú6Ú  Ú.Ô3  Ôà0  àÝ  ÝENERGY€AND€NATURAL€RESOURCES݃³´x¥£¥ÝŒÐˆ(#(# ÐŒÝ  ÝØØÓL€ h¥¤((gLÓÝ ‚³´ ÝÝ  ÝÝ‚³´Æ¦ÝÔ2¥¤ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€kinds€of€energy€(electric,€natural€gas,€oil,€wood€stove,€solar)€will€be€used€to€meetÐ \Ø Ðthe€completed€projectððs€energy€needs?€€Describe€whether€it€will€be€used€for€heating,Ïmanufacturing,€etc.݃³´Æ¦ñ¦ÝŒÐ (#(# ÐŒÝ  ÝÌÌÌÌÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´f¨ÝÔ2¥¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝWould€your€project€affect€the€potential€use€of€solar€energy€by€adjacent€properties?€€If€so,Ð x%ô!) Ðgenerally€describe.݃³´f¨‘¨ÝŒÐ (#(# ÐŒÝ  ÝÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´¬©ÝÔ2¥¤ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€kinds€of€energy€conservation€features€are€included€in€the€plans€of€this€proposal?€Ð p*ì&/ ÐList€other€proposed€measures€to€reduce€or€control€energy€impacts,€if€any:݃³´¬©×©ÝŒÐ (#(# ÐŒÝ  ÝÌÌÌÌÐ h/ä+5 ÐØØÓL€ qµ¤((hLÓÝ ‚³´ ÝÝ  ÝÝ‚³´¤«ÝÔ2µ¤ÔÚ  Ú7Ú  Ú.Ô3  Ôà0  àÝ  ÝENVIRONMENTAL€HEALTH݃³´¤«Ï«ÝŒÐ„(#(# ÐŒÝ  ÝÔ_ÔØØÓL€ v¥¤((qLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ú¬ÝÔ2¥¤ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝAre€there€any€environmental€health€hazards,€including€exposure€to€toxic€chemicals,€riskÐ XÔ Ðof€fire€and€explosion,€spill€or€hazardous€waste€that€could€occur€as€a€result€of€thisÏproposal.݃³´ú¬%­ÝŒÐ (#(# ÐŒÝ  ÝÌÌÌÌÓL€ wµ¤((vLÓÝ ‚ú» ÝÝ  ÝÝ‚ú»Ó®Ýà0  àÔ2µ¤ÔÚ  Ú1Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝDescribe€special€emergency€services€that€might€be€required.݃ú»Ó®þ®ÝŒÐ$  ` (#` (# ÐŒÝ  Ýà  àÌÌÌÝ ‚ú» ÝÝ  ÝÝ‚ú»ø¯Ýà0  àÔ2µ¤ÔÚ  Ú2Ú  Ú.Ô3  Ôà0` (#(#àÝ  ÝProposed€measures€to€reduce€or€control€environmental€health€hazards,€if€any:݃ú»ø¯#°ÝŒÐt ð ` (#` (# ÐŒÝ  ÝÌÌØØÓL€ tå¤((wLÓÝ ‚³´ ÝÝ  ÝÝ‚³´Œ±ÝÔ2å¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝNoise݃³´Œ±·±ÝŒÐðl (#(# ÐŒÝ  ÝØØÓL€ xŤ((tLÓÝ ‚³´ ÝÝ  Ýà  àÝ‚³´Ã²ÝÔ2ŤÔÚ  Ú1Ú  Ú.Ô3  Ôà0 ` àÝ  ÝWhat€types€of€noise€exist€in€the€area€which€may€affect€your€project€(for€example:Ð Ä@  Ðtraffic,€equipment,€operation,€other)?݃³´Ã²ú²ÝŒÐ ` (#` (# ÐŒÝ  ÝÌà  àÌÌÌÝ ‚³´ ÝÝ  Ýà  àÝ‚³´*´ÝÔ2ŤÔÚ  Ú2Ú  Ú.Ô3  Ôà0 ` àÝ  ÝWhat€types€and€levels€of€noise€would€be€created€by€or€associated€with€theÐ ¼8 Ðproject€on€a€short„term€or€long€term€basis€(for€example:€traffic,€construction,Ïoperation,€other)?€€Indicate€what€hours€noise€would€come€from€the€site.݃³´*´a´ÝŒÐ ` (#` (# ÐŒÝ  ÝÌà  àÌÌÌÝ ‚³´ ÝÝ  Ýà  àÝ‚³´úµÝÔ2ŤÔÚ  Ú3Ú  Ú.Ô3  Ôà0 ` àÝ  ÝProposed€measures€to€reduce€or€control€noise€impacts,€if€any:݃³´úµ1¶ÝŒÐˆ` (#` (# ÐŒÝ  ÝÌÌÌÌÌÌÌÌØØÓL€ yÕ¤((xLÓÝ ‚³´ ÝÝ  ÝÝ‚³´}·ÝÔ2Õ¤ÔÚ  Ú8Ú  Ú.Ô3  Ôà0  àÝ  ÝLAND€AND€SHORELINE€USE݃³´}·¨·ÝŒÐü"x&(#(# ÐŒÝ  ÝØØÓL€ zå¤((yLÓÝ ‚³´ ÝÝ  ÝÝ‚³´Å¸ÝÔ2å¤ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€is€the€current€use€of€the€site€and€adjacent€properties?݃³´Å¸ð¸ÝŒÐÐ#L '(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´Ë¹ÝÔ2å¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝHas€the€site€been€used€for€agriculture?€€If€so,€describe?݃³´Ë¹ö¹ÝŒÐ 'œ#+(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ÎºÝÔ2å¤ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝDescribe€any€structures€on€the€site.݃³´ÎºùºÝŒÐp*ì&/(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´¼»ÝÔ2å¤ÔÚ  ÚdÚ  Ú.Ô3  Ôà0  àÝ  ÝWill€any€structures€be€demolished?€€If€so,€what?݃³´¼»ç»ÝŒÐÀ-<*3(#(# ÐŒÝ  ÝÌÐ h/ä+5 ЇÝ ‚³´ ÝÝ  ÝÝ‚³´Ê¼ÝÔ2å¤ÔÚ  ÚeÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€is€the€current€zoning€classification€of€the€site?݃³´Ê¼õ¼ÝŒÐ„(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´Ê½ÝÔ2å¤ÔÚ  ÚfÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€is€the€current€comprehensive€plan€designation€of€the€site?݃³´Ê½õ½ÝŒÐÔP(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´Ó¾ÝÔ2å¤ÔÚ  ÚgÚ  Ú.Ô3  Ôà0  àÝ  ÝIf€applicable,€what€is€the€current€shoreline€master€program€designation€of€the€site?݃³´Ó¾þ¾ÝŒÐ$  (#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ñ¿ÝÔ2å¤ÔÚ  ÚhÚ  Ú.Ô3  Ôà0  àÝ  ÝHas€any€part€of€the€site€been€classified€as€an€ð ðenvironmentally€sensitiveðð€area?€€If€so,Ð t ð  Ðspecify.݃³´ñ¿À݌Р(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´-ÁÝÔ2å¤ÔÚ  ÚiÚ  Ú.Ô3  Ôà0  àÝ  ÝApproximately€how€many€people€would€reside€or€work€in€the€completed€project?€_____݃³´-ÁXÁÝŒÐÄ@ (#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´GÂÝÔ2å¤ÔÚ  ÚjÚ  Ú.Ô3  Ôà0  àÝ  ÝApproximately€how€many€people€would€the€completed€project€displace?€_____݃³´GÂrÂÝŒÐlè(#(# ÐŒÝ  ÝÌÝ ‚³´ ÝÝ  ÝÝ‚³´XÃÝÔ2å¤ÔÚ  ÚkÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€avoid€or€reduce€displacement€impacts,€if€any:݃³´XÃÃÝŒÐ(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´dÄÝÔ2å¤ÔÚ  ÚlÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€ensure€the€proposal€is€compatible€with€existing€and€projectedÐ dà Ðland€uses€and€plans,€if€any:݃³´dÄÄ݌Р(#(# ÐŒÝ  ÝÌÌÌÌÌÌÌÌØ ØÓL€ {õ¤((zLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ÆÝÔ2õ¤ÔÚ  Ú9Ú  Ú.Ô3  Ôà0  àÝ  ÝHOUSING݃³´ÆDÆ݌Ь("(#(# ÐŒÝ  ÝØ ØÓL€ |¥(({LÓÝ ‚³´ ÝÝ  ÝÝ‚³´RÇÝÔ2¥ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝApproximately€how€many€units€would€be€provided,€if€any?€€Indicate€whether€high,€middleÐ € ü# Ðor€low„income€housing.݃³´RÇ}Ç݌Р(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´”ÈÝÔ2¥ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝApproximately€how€many€units,€if€any€would€be€eliminated?€€Indicate€whether€high,Ð Ð#L ' Ðmiddle€or€low„income€housing.݃³´”È¿È݌Р(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ØÉÝÔ2¥ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€housing€impacts,€if€any:݃³´ØÉÊ݌Р'œ#+(#(# ÐŒÝ  ÝÌÌØ ØÓL€ ¥((|LÓÝ ‚³´ ÝÝ  ÝÝ‚³´KËÝÔ2¥ÔÚ  Ú10Ú  Ú.Ô3  Ôà0  àÝ  ÝAESTHETICS݃³´KËvË݌М)&.(#(# ÐŒÝ  ÝØ ØÓL€ ƒ%¥((LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ˆÌÝÔ2%¥ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€is€the€tallest€height€of€any€proposed€structure(s),€not€including€antennas;€what€isÐ p*ì&/ Ðthe€principal€exterior€building€material(s)€proposed?݃³´ˆÌ³Ì݌Р(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ìÍÝÔ2%¥ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€views€in€the€immediate€vicinity€would€be€altered€or€obstructed?݃³´ìÍÎ݌Д.+4(#(# ÐŒÝ  ÝÐ h/ä+5 ЇÝ ‚³´ ÝÝ  ÝÝ‚³´ ÏÝÔ2%¥ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€aesthetic€impacts,€if€any:݃³´ Ï8Ï݌Є(#(# ÐŒÝ  ÝÌÌØ ØÓL€ †Õ¤((ƒLÓÝ ‚³´ ÝÝ  ÝÝ‚³´‚ÐÝÔ2Õ¤ÔÚ  Ú11Ú  Ú.Ô3  Ôà0  àÝ  ÝLIGHT€AND€GLARE݃³´‚ЭÐÝŒÐ|(#(# ÐŒÝ  ÝØ ØÓL€ ‡å¤((†LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ÄÑÝÔ2å¤ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€type€of€light€or€glare€will€the€proposal€produce?€€That€time€of€day€would€it€mainlyÐ ÔP Ðoccur?݃³´ÄÑïÑ݌Р(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´øÒÝÔ2å¤ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝCould€light€or€glare€from€the€finished€project€be€a€safety€hazard€or€interfere€with€views?݃³´øÒ#ÓÝŒÐ$  (#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ÔÝÔ2å¤ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€existing€off„site€sources€of€light€or€glare€may€affect€your€proposal?݃³´ÔFÔ݌Р  (#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´.ÕÝÔ2å¤ÔÚ  ÚdÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€light€and€glare€impacts,€if€any:݃³´.ÕYÕ݌И (#(# ÐŒÝ  ÝÌÌÌØ ØÓL€ ˆõ¤((‡LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ªÖÝÔ2õ¤ÔÚ  Ú12Ú  Ú.Ô3  Ôà0  àÝ  ÝRECREATION݃³´ªÖÕÖÝŒÐlè(#(# ÐŒÝ  ÝØ ØÓL€ ‹¥((ˆLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ç×ÝÔ2¥ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝWhat€designated€and€informal€recreational€opportunities€are€in€the€immediate€vicinity?݃³´ç×ØÝŒÐ@¼(#(# ÐŒÝ  ÝÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ÙÝÔ2¥ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝWould€the€proposed€project€displace€any€existing€recreational€uses?€€If€so,€describe.݃³´Ù3ÙÝŒÐdà(#(# ÐŒÝ  ÝÌÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´)ÚÝÔ2¥ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€impacts€on€recreation,€including€recreationalÐ \Ø Ðopportunities€to€be€provided€by€the€project€or€applicant,€if€any:݃³´)ÚTÚ݌Р(#(# ÐŒÝ  ÝÌÌÌÌØ ØÓL€ Œ%¥((‹LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ÜÝÔ2%¥ÔÚ  Ú13Ú  Ú.Ô3  Ôà0  àÝ  ÝHISTORIC€AND€CULTURAL€PRESERVATION݃³´Ü,ÜÝŒÐT!Ð$(#(# ÐŒÝ  ÝØ ØÓL€ 5¥((ŒLÓÝ ‚³´ ÝÝ  ÝÝ‚³´VÝÝÔ25¥ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝAre€there€any€places€or€objects€listed€on,€or€proposed€for,€national,€state€or€localÐ ("¤% Ðpreservation€registers€known€to€be€on€or€next€to€the€site?€€If€so,€generally€describe.݃³´VÝÝ݌Р(#(# ÐŒÝ  ÝÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ØÞÝÔ25¥ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝGenerally€describe€any€landmarks€or€evidence€of€historic,€archaeological,€scientific€orÐ  'œ#+ Ðcultural€importance€known€to€be€on€or€next€to€the€site.݃³´ØÞß݌Р(#(# ÐŒÝ  ÝÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´>àÝÔ25¥ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€impacts,€if€any:݃³´>àiàÝŒÐ,”(1(#(# ÐŒÝ  ÝÌÌÌÐ h/ä+5 ÐØ ØÓL€ E¥((LÓÝ ‚³´ ÝÝ  ÝÝ‚³´¿áÝÔ2E¥ÔÚ  Ú14Ú  Ú.Ô3  Ôà0  àÝ  ÝTRANSPORTATION݃³´¿áêá݌Є(#(# ÐŒÝ  ÝØØÓL€ ½U¥((LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ãÝÔ2U¥ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝIdentify€public€streets€and€highways€serving€the€site,€and€describe€proposed€access€toÐ XÔ Ðthe€existing€street€system.€€Show€on€site€plans,€if€any.݃³´ã+ã݌Р(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´eäÝÔ2U¥ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝIs€the€site€currently€served€by€public€transit?€€If€no,€what€is€the€approximate€distance€toÐ |ø Ðthe€nearest€transit€stop?݃³´eää݌Р(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´°åÝÔ2U¥ÔÚ  ÚcÚ  Ú.Ô3  Ôà0  àÝ  ÝHow€many€parking€spaces€would€the€completed€project€have?€________݃³´°åÛå݌Р  (#(# ÐŒÝ  Ýà  àHow€many€would€the€project€eliminate?€_____ÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´òæÝÔ2U¥ÔÚ  ÚdÚ  Ú.Ô3  Ôà0  àÝ  ÝWill€the€proposal€require€any€new€roads€or€streets,€or€improvements€to€existing€roads€orÐ ˜  Ðstreets,€not€including€driveways?€€If€so,€generally€describe€(indicate€whether€public€orÏprivate).݃³´òæç݌Р(#(# ÐŒÝ  ÝÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ƒèÝÔ2U¥ÔÚ  ÚeÚ  Ú.Ô3  Ôà0  àÝ  ÝWill€the€project€use€(or€occur€in€the€immediate€vicinity€of)€water,€rail€or€air€¢trasportation£?€Ð  ÐIf€so,€generally€describe.݃³´ƒè®è݌Р(#(# ÐŒÝ  ÝÌÌÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´ÖéÝÔ2U¥ÔÚ  ÚfÚ  Ú.Ô3  Ôà0  àÝ  ÝHow€many€vehicular€trips€per€day€would€be€generated€by€the€completed€project?€€IfÐ  ˆ Ðknown,€indicate€when€peak€volumes€would€occur݃³´Öéê݌Р(#(# ÐŒÝ  ÝÓL€ ‰Zú((½LÓÌÌÓL€ rú((‰LÓÌÓL€ ¾e¥((rLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ìÝÔ2e¥ÔÚ  ÚgÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€transportation€impacts,€if€any:݃³´ì:ìÝŒÐ0¬(#(# ÐŒÝ  ÝÌÌÌØØÓL€ ¿¥((¾LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ŠíÝÔ2¥ÔÚ  Ú15Ú  Ú.Ô3  Ôà0  àÝ  ÝPUBLIC€SERVICES݃³´Šíµí݌Ѐ ü#(#(# ÐŒÝ  ÝØØÓL€ À%¥((¿LÓÝ ‚³´ ÝÝ  ÝÝ‚³´ÌîÝÔ2%¥ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝWould€the€project€result€in€an€increased€need€for€public€services€(for€example:€fireÐ T!Ð$ Ðprotection,€police€protection,€health€care,€schools,€other)?€€If€so,€generally€describe.݃³´Ìî÷î݌Р(#(# ÐŒÝ  ÝÌÌÝ ‚³´ ÝÝ  ÝÝ‚³´NðÝÔ2%¥ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝProposed€measures€to€reduce€or€control€direct€impacts€on€public€services,€if€any:݃³´Nðyð݌Ф$ !((#(# ÐŒÝ  ÝÌÌÌØØÓL€ Á5¥((ÀLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ÔñÝÔ25¥ÔÚ  Ú16Ú  Ú.Ô3  Ôà0  àÝ  ÝUTILITIES݃³´ÔñÿñÝŒÐô'p$,(#(# ÐŒÝ  ÝØØÓL€ ÂE¥((ÁLÓÝ ‚³´ ÝÝ  ÝÝ‚³´óÝÔ2E¥ÔÚ  ÚaÚ  Ú.Ô3  Ôà0  àÝ  ÝCircle€utilities€currently€available€at€the€site:€electricity,€natural€gas,€water,€refuse€service,Ð È(D%- Ðtelephone,€sanitary€sewer,€septic€system,€other:€____________________݃³´ó;ó݌Р(#(# ÐŒÝ  ÝÌÔ_ÔÌÝ ‚³´ ÝÝ  ÝÝ‚³´ôÝÔ2E¥ÔÚ  ÚbÚ  Ú.Ô3  Ôà0  àÝ  ÝDescribe€the€utilities€that€are€proposed€for€the€project,€the€utility€providing€the€serviceÐ ,”(1 Ðand€the€general€construction€activities€on€the€site€or€in€the€immediate€vicinity€whichÏmight€be€needed.݃³´ôÈô݌Р(#(# ÐŒÝ  ÝÌÐ h/ä+5 Ðà  àà ` àà ¸ àà  àà h àÌÓL€ Īú((ÂLÓÝ ‚³´ ÝÝ  ÝÝ‚³´ÒöÝÔ2ªúÔÚ  ÚCÚ  Ú.Ô3  Ôà0  àÝ  ÝSIGNATURE݃³´ÒöýöÝŒÐXÔ(#(# ÐŒÝ  ÝÌà0  àThe€above€answers€are€true€and€complete€to€the€best€of€my€knowledge.€€I€understandÏthat€the€lead€agency€is€relying€on€them€to€make€its€decision.Ð (#(# ÐÌà  àSIGNATURE:_______________________________________ÌÌà  àDATE€SUBMITTED:______________________________________ÌÌÌÌà  àà ` àà ¸ àà  àÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÔ#†&˜2 %%&tPÛ#ÔÔ#†X„=X %&˜2*Q#Ôœ