00847Yes Maybe No
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AW
(17) Human Ilea It•>>. Will the proposal
T
2
=cti'u7.t in creation of any
,.
._ • 3
health l9itz�. c ar potential health
41
hazard (excluding mental licalth)? x
;
'
6
Explanation:
7
;
f.
8
9'
(18) Aesthetics. ,Will the proposal
�}
Y
10
resule in the obstruction of any
11
scenic vista or view open to the
}:
12
:public, or will the -proposal re-'
p
13
suit in the creation of an
14
aesthetically offensive site open
15
to public view?
s
16
17
Explanation:;
19.
20
(19) Recreation. Will the proposal
21
result in an Ampact upon the
22
quality or quantity of existing
pf
23
recreational opportunities?
t
4
24
w,
25
Explanation:
;
2G
27
t
'
28
'(26) Archeolo * c:al/lli storical . Will the
�r
29
proposal result in An alteration of
30
a significant archeological or his-
31
- torical site, structure, object
32
or building?
33
34
Explanation:
x-
35
37
III. SIGNATU107,
38
!
39
I, the undersigned, state that to the best of my knowledge
40
the above information is.t'rue and complete. It is understood
41
42
that the: lead aE;ency may withdraw any declaration of non-signi-
ficance that it might issue in
43
reliance upon this checklist
should -there be any misrepresentation'or lack of full disclosure
44
on pare.
45
46
Proponent:
47
48
WAC 197-1.0-370. WITIIDRAWAL OF AFF ,',bVfIVE THRL••S110LD
49
DGTL:'R f "TATIOly . ;1
i� at any time after the entry of a declara-
'
50
51
Lion of 'significance, the proponent modifies the proposal
52
so. that, in the judglll'ent of the lead agency, all significant
adverse environmental impacts resulting therefrom are elimin-
53
54
ated, the declaration of significance shall be withdrawn
55
and a declaration of 11011-S41-lificance -entered instead. The
lead
..
56
agency shall also revise the registers at its SEPA
public information center accordingly. If the
t
57
58
pro-`
pouent of a proposal is a private applicant, the proposal
54
shall not: be considered modified until all license applica-
tions for the
proposal are revised to reflect the modification.
q
-37-
7
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