ENVIRONMENTAL IMPACT ASSESSMENT FORM

INSTRUCTION SHEET FOR FILLING OUT
ENVIRONMENTAL IMPACT ASSESSMENT FORM – PART I

The Environmental Impact Assessment (EIA) Form – Part I will be used to determine what type of environmental documentation (i.e. Environmental Impact Report, Mitigated Negative Declaration, Negative Declaration or Exemption) that will be required to be prepared for your application, per the California Environmental Quality Act (CEQA).

The clarity and accuracy of the information you provide is critical for purposes of quickly determining the specific environmental. Effects of your project.

Recent judicial decisions have held that a "naked checklist", that is a checklist that is merely checked "yes" or "no", is insufficient to comply with the requirements of the California Environmental Quality Act. Each "yes" or "no" answer must be accompanied by a written explanation justifying the "yes" or "no" answer. This is especially important when a Negative Declaration is being sought. The more information provided in this form, the easier and quicker it will be for Staff to complete the Environmental Impact Assessment Form – Part II.

Please be aware that recently adopted State Law (Assembly Bill 3158, Chapter 1702 of the Regular Session) requires all projects requiring an Environmental Impact Report (EIR) or Negative Declaration (ND) pay a filing fee to the County Clerk. If a project may pose a potential impact on "Wildlife Resources"; this State Law also requires paying a fee to the State Department of Fish & Game. As such, if there may be a potential impact on "wildlife Resources" one of the following conditions will be placed on all projects requiring an EIR or ND:

1. Name and address of developer or project sponsor: ___________________________

2. Address of project: ______________________________________________________________________

3. Name, address, and telephone number of person to be contacted concerning this project:

4. Indicate number of the permit application for the project to which this form pertains:

5. List and describe any other related permits and other public approvals required for this project, including those required by City, regional, state and federal agencies:

6. Existing zoning districts: ______________________________________________________________________

8. Site Size: ______________________________________________________________________

9. Square footage: _____________________________________________________________________

10. Number of floors of construction: _____________________________________________________________________

11. Amount of off-street parking provided: _____________________________________________________________________

13. Proposed scheduling: ______________________________________________________________________

14. Associated projects: ______________________________________________________________________

15. Anticipated incremental development: ______________________________________________________________________

16. If residential, include the number of units, schedule of unit sizes, range of sale prices or rents and type of household size expected: ______________________________________________________________________

17. If commercial, indicate the type, whether neighborhood, city or regionally oriented, square footage of sales area, and loading facilities:

18. If industrial, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project:

19. If institutional, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project:

20. If the project involves a variance, conditional use or rezoning application, state this and indicate clearly why the application is required:

Are the following items applicable to the project or its effects? Discuss below all items checked yes (attach additional sheets as necessary).

YES	NO
		21.	Change in existing features or any bays, tidelands, beaches, lakes or hills, or substantial alteration of ground contours.
		22.	Change in scenic views or vistas from existing residential areas or public lands or roads.
		23.	Change in pattern, scale or character of general area of project.
		24.	Significant amounts of solid waste or litter.
		25.	Change in dust, ash, smoke, fumes or odors in vicinity.
		26.	Change in ocean, bay, lake, stream or ground water quality or quantity, or alteration of existing drainage patterns.
		27.	Substantial change in existing noise or vibration levels in the vicinity.
		28.	Site on filled land or on slope of 10 percent or more.
		29.	Use of disposal of potential hazardous materials, such as toxic substances, flammable or explosives.
		30.	Substantial change in demand for municipal services (police, fire, water, sewage, etc.)
		31.	Substantially increase fossil fuel consumption (electricity, oil, natural gas, etc.)
		32.	Relationship to a larger project or series of projects.

33. Describe the project site as it exists before the project, including information on topography, soil stability, plants and animals, and any cultural, historical or scenic aspects. Describe any existing structures on the site, and the use of the structures. Attach photographs of the site. Snapshots or polaroid photos will be accepted.

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34. Describe the surrounding properties, including information on plants and animals and any cultural, historical or scenic aspects. Indicate the type of land use (residential, commercial, etc.), intensity of land use (one-family, apartment houses, shops, department stores, etc.), and scale of development (height, frontage, setback, rear yard, etc.). Attach photographs of the vicinity. Snapshots or polaroid photos will be accepted.

I hereby certify that the statements furnished above and in the attached exhibits present the data and information required for this initial evaluation to the best of my ability, and that the facts, statements and information presented are true and correct to the best of my knowledge and belief.