01148 (2)PROJECnAME
DATE' SUBIMITiTED
EHVI M HVITAL ASSESSME'IT
In order to meet the requirements of the State Environmental Policy Act of 1971,
the responsible official must make a declaration of environmental impact as early
as possible in the process of evaluating a project.
The information in this form -aill be used to determine whethe
r it will be necess-.
ary to require an environmental lmnact*staterient. If an impact statementJs
not -required, a Statement of Hegative Declaration will be placed in the file.
Ifan impact statement is -required, a draft statement must be filed with this
office, public notice given and a review period of 30' days allowed. The final
statement and comments must be filed with the Department of Ecology, Office of
the Governor and the Ecological.Commission.
The Edmonds Planning Staff will assist you in any way we can in accumMating
this Information and we would appreciate your cooperation.
1. Land:
Area in acres
Soils type 1C 1, ChIf I Limitations,-P
(: VO
77,
Description of topography (% slope)
Lt '"ff ff If grading- or filling
Grading: esti-mated cubic yds. &Ak� VVI R/:- ti
exceed 500 cubic yards
wi
cubic yds. R&I iva,4 or grading and filling plan estimated
must be submitted with the
2. Water: application. ;J
Stream estimated flow (cubic feet per second)
Will stream be -altered? IRVA
Impact on storm drainage (increase in run-off) Al
is
Estimated area to be paved %
Estimated area in open space Ci %
Shorelines: within 200 ft. of Hean Hig;1er High tla ter Adjacent to shorelines zone
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