Fillable Short Environmental Assessment Form printable pdf download

Short Environmental Assessment Form

Part 1 - Project Information

Instructions for Completing

Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses

become part of the application for approval or funding, are subject to public review, and may be subject to further verification.

Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully

respond to any item, please answer as thoroughly as possible based on current information.

Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful

to the lead agency; attach additional pages as necessary to supplement any item.

Part 1 - Project and Sponsor Information

Name of Action or Project:

Applying a Special Use Permit for an Extension or Enlargement of non-conforming use

Project Location (describe, and attach a location map):

1610 Dryden Road, Tax Parcel #: 44.-1-13.412

Brief Description of Proposed Action:

The property located at 1610 Dryden Rd. has been used as a retail store of used books since mid 1980s, known as Phoenix Books. The

property will continue to be used as a general retail store including but not limited to trailers and trailer components.

The following three actions will be involved.

1. To apply a Special Use Permit for outside storage or display of trailers.

2. To continue using the existing sign structure for new business.

3. To improve the landscape on the east side of barn where trailers will be parked.

Name of Applicant or Sponsor:

Telephone:

607-227-9636

John Guo

E-Mail:

Address:

325 Winthrop Drive

City/PO:

State:

Zip Code:

Ithaca

14850

1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance,

YES

administrative rule, or regulation?

If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that

may be affected in the municipality and proceed to Part 2. If no, continue to question 2.

2. Does the proposed action require a permit, approval or funding from any other governmental Agency?

YES

If Yes, list agency(s) name and permit or approval:

3.a. Total acreage of the site of the proposed action?

___________ acres

28.5

b. Total acreage to be physically disturbed?

___________ acres

c. Total acreage (project site and any contiguous properties) owned

or controlled by the applicant or project sponsor?

___________acres

28.5

4. Check all land uses that occur on, adjoining and near the proposed action.

9 Urban

9 Rural (non-agriculture)

9 Industrial

9 Commercial

9 Residential (suburban)

9 Forest

9 Agriculture

9 Aquatic

9 Other (specify): _________________________

9 Parkland

Page 1 of 3

Short Environmental Assessment Form

Related Articles

Related forms

Related Categories