HomeMy WebLinkAboutEnvironmental AssessmentCITY OF PALM DESERT
DEPARTMENT OF DEVELOPMENT SERVICES
73510 Fred Waring Drive, Palm Desert, California 92260
Phone (760) 776-6435 ▪ Fax (760) 776-6392 ▪ permitcenter@cityofpalmdesert.org
ENVIRONMENTAL ASSESSMENT FORM
TO THE APPLICANT: Your cooperation in completing this form and supplying the information requested will
expedite the review of your application pursuant to the California Environmental Quality Act (CEQA). The City is
required to review the environmental impacts for all projects through an environmental assessment. Applications
will not be considered complete until all the necessary information to make the environmental assessment is
complete.
Applicant Name:
Phone:
Mailing Address: Fax:
City: State: Zip: Email:
Property Owner Name:
Phone:
Mailing Address: Fax:
City: State: Zip: Email:
Representative:
Phone:
Mailing Address: Fax:
City: State: Zip: Email:
Please Send Correspondence to (Check One): Applicant Property Owner Representative
Project Name (if any):
Project Location (street address/general location):
Precise Legal Description of the Property (lot and tract number, or meets and bounds):
Proposed Use of the Site (project for which the form is filed; describe the total undertaking, not just the current application
approval being sought):
Relationship to a Larger Project or Series of Projects (describe how this project relates to other activities, phases,
developments planned, or now underway):
List and describe any other related permits and other public approvals required for this project to go forward, including those
required by the City, Regional, State, and Federal agencies (indicate subsequent approval agency name and type of approval
required):
CITY OF PALM DESERT
ENVIRONMENTAL ASSESSMENT FORM
2
I.EXISTING CONDITIONS:
1.Project Site Area (size of property in square feet or acreage):
2.Existing Zoning: Proposed Zoning:
3.General Plan Designation:
4.Existing Use of the Project Site:
5.Existing Use on Adjacent Properties (Example: north, shopping center; south, single-family dwellings; etc.):
North:
South:
East:
West:
6.Site Topography (describe):
7.Are there any natural or manmade drainage channels through or adjacent to the property? No Yes
8.Grading (estimate number of cubic yards of earth being moved):
9.List the number, size, and type of trees being moved:
10.Describe any cultural, historic, or scenic aspects of the project site:
11.Residential Project (Note: If not residential, do not complete this section):
A.Number and type of dwelling units (specify number of bedrooms):
B.Schedule of Unit Sizes:
C.Number of Stories: Height Feet
D.Largest Single Building (square feet):___ Height Feet
E.Type of Household size Expected (population projection of the project):
F.Describe the Number and Type of Recreational Facilities:
G.Is There any Night Lighting of the Project: No Yes
H.Range of Anticipated Sale Prices or Rent: $ to $
CITY OF PALM DESERT
ENVIRONMENTAL ASSESSMENT FORM
3
I.Percent of total Project Devoted to:
Building: ............................................................................ %
Paving (including Streets): ................................................ %
Landscaping and Open Space (Recreation Area) ............ %
12.Commercial, Industrial, Institutional, or Other Projects:
A.Type of Use(s) and Major Function(s). If offices, specify type and number:
B.Number of Square Feet in Total Building Area:
C.Number of Stories: Height Feet
D.Largest Single Building (square feet):Height Feet
E.Number of Square Feet in Outdoor Storage Area:
F.Total Number of Required Parking Spaces:
Number of Parking Spaces Provided:
G.Hours of Operation:
H.Maximum Number of Clients, Patrons, Shoppers, etc. at One Time:
I.Maximum Number of Employees at One Time:
J.If Patron Seating is Involved, State the Number:
K.Is There any Night Lighting of the Project: No Yes
L.Percent of Total Project Devoted to:
Building: ............................................................................ %
Paving (including Streets): ................................................ %
Landscaping and Open Space (Recreation Area) ............ %
Are the following Items applicable to the project or its effects? Discuss below all items checked yes (attach additional
sheets as necessary).
YES NO
1.Change in existing features of hillside, or substantial alteration
of ground contours.
2.Change in the dust, ash, smoke, fumes, or odors in the project
vicinity.
3.Subject to or resulting in soil erosion by wind or flooding.
4.Change in ground water quality or quantity, or alteration of
existing drainage patterns.
5.Change in existing noise or vibration level in the vicinity.
Subject to roadway or airport noise. (Has the required
acoustical report been submitted?)
CITY OF PALM DESERT
ENVIRONMENTAL ASSESSMENT FORM
4
YES NO
6.Involves the use or disposal of potentially hazardous materials,
such as toxic substances, flammables, or explosives,
7.Involves the use of substantial amounts of fuel or energy.
8.Changes in demand for municipal services (police, fire,
sewage, etc.).
9.Changes in demand for utility services beyond those presently
available or planned in the near future.
10.Significantly affects any unique or natural features, including
mature trees.
11.Change in scenic views, vistas from existing residential areas,
public land, or public roads.
12.Results in the dislocation of people.
13.Generates controversy based on aesthetics or other features of
the project.
14.Attached are additional pages for the explanation of items that
were answered “YES.”
Certification: 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 or belief.
Print Name: Signature: Date: