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HomeMy WebLinkAbout1260 . . PLANNING COMMISSION RESOLUTION 1260 A RESOLUTION DENYING CONDITIONAL USE PERMIT 84-8 A REQUEST TO EXPAND THE EXISTING CONVALESCENT HOSPITAL FROM 74 BEDS TO 160 BEDS AT 1601 SOUTH BALDWIN AVENUE. WHEREAS, on April 16, 1984, an application was filed by Orlando C1arizio to expand the existing 74 bed convalescent hospital to 160 beds, Planning Department Case No. C.U.P. 84-8, on property commonly known as 1601 South Baldwin Avenue, more particularly described as follows: Portion of Lot 4, Block G in the Santa Anita Land Company's Tract, located in the City of Arcadia, County of Los Angeles, State of California. WHEREAS, a public hearing was held on May 8, 1984 at which time all interested persons were given full opportunity to be heard and to present evidence; and . WHEREAS, pursuant to review of the record including staff reports and testimony, the Planning Commission directed preparation of this Resolution to reflect their decision and findings. NOW, THEREFORE, THE PLANNING COMMISSION OF THE CITY OF ARCADIA HEREBY RESOLVES AS FOLLOWS: Section 1., That the factual data submitted by the Planning Commission in the attached report is true and correct. Section 2. This Commission finds: 1. That the proposed expansion is too intense for the subject site and that it does not comply with Section 9275.5.3 of the Arcadia Municipal Code which allows a maximum of one bed for each 800 square feet of lot area. 2. The site for the proposed use is inadequate in that the 20' wide driveway to the rear parking area is unsafe and inadequate. Section 3. That for the foregoing reasons this Commission determines that the granting of Conditional Use permit 84-8 will be detrimental to the welfare of property in the vicinity, injurious to such property and inconsistent with the proper develOpment in the neighborhood and zone and, therefore, denies the application for . Conditional Use Permit 84-8. - 1 - 1260 . Section 4. The decision, findings and conditions contained in this Resolution reflect the Commission's action of May 8, 1984, and the following vote: AYES: Commissioners Fee, Hedlund, Sargis, Szany, Wells, Jahnke NOES: None ABSENT: Commissioner Dixon Section 5. The Secretary shall certify to the adoption of this Resolution and shall cause a copy to be forwarded to the Ci ty Council of the Ci ty of Arcadi a. I HEREBY CERTIFY that the foregoing Resolution was adopted at a regular meeting of the Planning Commission held on the 22nd day of May, 1984, by the fo 11 owi ng vote: AYES: NOES: ABSENT: Commissioners Dixon, Fee, Hedlund, Szany, Wells, Sargis None Commissioner Jahnke ATTEST: Cha i rman, City of Arcadia g Commission . d~~ Secretary, Planning Commission Ci ty of Arcadi a . - 2 - 1260 . . . May 8, 1984 TO: ARCADIA CITY PLANNING COMMISSION FROM: PLANNING DEPARTMENT CASE NO.: C.U.P. 84-8 PREPARED BY: DONNA L. BUTLER ASSOCIATE PLANNER GENERAL INFORMATION APPL ICANT: Orlando Clarizio LOCATION: 1601 South Baldwin Avenue REQUEST: Conditional use permit and related modifications to expand the existing convalescent hospital from 74 beds to 160 beds LOT AREA: 94,200+ square feet (2.16 acres) FRONTAGE: 204+ feet on Baldwin Avenue EXISTING LAND USE ol. ZONING: The subject site is developed with a' 74 bed convalescent hospital; zoned R-3 SURROUNDING LAND USE ol. ZONING North: Developed with a retirement facil ity, vacant lot and residential uses; zoned R-3 and R-2 respectively Developed with single family dwel I 'ngs; zoned R-I Developed with apartments and single family dwel lings; zoned R-3 and R-I Developed with single-family dwel lings; zoned R-I South: East: West: GENERAL PLAN DESIGNATION: Multiple-family residential H I STORY On November 15, 1960 the City Council granted to Mr. Orlando Clarlzlo a zone variance (V-60-101 to construct and operate a 66 bed convalescent hospital on the subject property. This proposal provided for 54 parking spaces. In March, 1966 the Planning Commission denied Conditional Use Permit 66- 5, a request by Mr. Clarlzlo to expand the convalescent hospital to 193 beds. Ths proposal Involved adding a one story addition on tie south ~ side of the building adjacent to the residential properties on Cal I ita Street and a three story addition along Baldwin Avenue. Ninety-seven parking spaces were proposed. This appl ication was denied on the basis that it exceeded the maximum density al lowed by code and the height limit and setback requirements as established by code. (The property at this time was zoned R-1.) In November, 1966 Mr. Clarizio filed another appl ication (C.U.P. 66-17) to expand the existing convalescent hospital from 66 beds to 176 beds. Mr. Clarizio proposed to construct a two story addition along Baldwin Avenue and a one story addition on the south side of the property adjacent to the Cal lita Street properties. Again it was noted that the number of beds exceeded the allowable density regulations establ ished by the zoning ordinance for convalescent facl I ities. This application was denied. . In August, 1967 Mr. Clarizio filed C.U.P. 67-2 which requested a conditional use permit to expand his existing hospital by adding 44 beds and also construct an 80 unit retirement faci I Ity on the property north of this site fronting on Baldwin Avenue and Cam no Real, This application was denied by the Planning Comission and the City Council based upon the fact that the convalescent hospital exceeded the density of development permitted by the original variance and that the proposed expansion would encroach into the existing open space and would be too close to the properties fronting on Cal lita Street. Mr. Clarizio filed another application in October, 1967 (C.U.P. 67-7) to add 100 beds to the existing convalescent hospital and construct a 78 bed retirement faci lity on the property north of this site fronting on Badlwin Avenue and Camino Real. This appl ication was approved by the Planning Commission and City Council, however, construction of this addition was never commenced. In January, 1984, Mr. Clarizio filed C.U.P. 84-2 which requested a conditional use permit to expand the existing hospital to 170 beds. This application was denied by the Planning Commission and City Council with the finding that the proposal was too intense and that although 86 parking spaces were being proposed, 21 of these spaces were tandem spaces which did not comply with the code. SPECIAL INFORMATION Existing Building: The existing building contains approximately 20,555 square feet and 74 beds. The existing buildings, with the exception of the Administration building are 15+ feet in height with a white gravel roof. . C.U,P. 84-8 5/8/84 Page 2 . The administration building is set back approximately 85 feet from the Baldwin Avenue property I ine and the hospital bui Idings are set back approximately 150+ feet from Baldwin Avenue property line. There is a 61' rear yard setback and 151 to 25' setback from the northerly property line, The existing hospital wings have the fol lowing setbacks from the adjoining rear property I ine of the residential properties on Cal I ita Street: Easterly wing (closest to Baldwin Avenue) Midd Ie Wi ng Rear Wing (adjacent to westerly parking lot) 22' setback 64' setback Approx. 125' setback The current density is one bed for each 1,273 square feet of lot area. The buildings cover approximately 21% of the lot. There is presently 17,700 square feet of interior open space, excluding the 10' landscape buffer along the southerly property line. An incinerator/trash area is located at the northwest corner of the property. Staff observed that the trash b n cannot be placed inside the enclosure and trash was located in and out of the trash bin. Existing Parking . There are currently a total of 46 parking spaces on the site. Twenty-two parking spaces are located in front of the hospital; 17 spaces are located at the rear of the lot and seven paral lei parking spaces are located along the southerly driveway. Ten parking spaces have been deleted in the rear parking area and developed with a planting area. There are two driveway entrances located on Baldwin Avenue. An I I' wide driveway along the northerly property line and an 11'+ wide driveway along the southerly property I ine adjacent to the residential properties fronting on Cal I Ita Street. This second driveway is separated from the adjoining residential properties by a ten foot wide landscape buffer. Both of these driveways are for one way circulation only. Proposed Sui Iding The applicant is proposing to add 23,400 square feet of floor area. The one- story administration building located adjacent to Baldwin Avenue wil I be demolished, Approximately 610 square feet of the existing building wil I be removed in order to widen the driveway along the north side of the property. The total square footage for the entire convalescent hospital wil I be approxImately 42,400 square feet. The appl icant is pr )posin'] to add 86 more beds for a total of 160 beds. . C.U.P, 84-8 ~~8t8~ . The new single story wing fronting on Baldwin Avenue wil I be approximately 2\ feet in height. The remainder of the new bui Idings wi I I maintain the same roof line as the existing building and wil I be approximately 15+ feet In height. This new wing wi I I be set back approximately 40 feet from the BaldwIn Avenue property Ii Ie, ten feet from the southerly property line (adjacent to the residential properties on Cal lita Avenue) and 25 feet from the northerly property line. The remainder of the new bui Idings wll I be set back 10 to 24 feet from the southerly property line and 50 feet from the rear (westerly) property line. The proposed density wi I I be one bed for each 589+ square feet of lot area. The code al lows a maximum density of one bed for each 800 square feet of lot area. The facil ity wi I I contain 14 one-bed rooms; 33 two-bed rooms and five three- bed rooms for a total of 160 beds. The revised plans wll I have approximately 11,876 square feet of Interior open space and a maximum building coverage of approximately 45%. . The new wing fronting on Baldwin Avenue wi I I have a cement plaster exterior with a clay tile roof. The remaining new buildings wil I have cement plaster exterior with a white rock roof to match the existing buildings. Proposed Parking and Landscaping Based on the parking requirement of one parking space for every two beds, 80 parking spaces would be required. The appl icant is proposing 61 parking spaces. The parking will be distributed as follows: 27 parking sepaces wll I be located to the rear of the building; 13 of these spaces wi I I be standard spaces; II wi I I be compact spaces and two wll I be handicap spaces. 34 parking spaces wi I i be located in the subterranean parking area located under the easterly portion of the building; 32 of these spaces wil I be standard spaces an~ two wll I be compact spaces, Ingress and egress to the rear parking area wil I be from one drlvewway located along the northerl,y property line. This driveway wil I be 20 feet In width. The existing southerly driveway wil I be removed. Ingress and egress to the subterranean parking area wil I be from a drIveway located approximately 12 feet north of the southerly property line. This driveway wil I be approximately 26 feet in width. . C.U.P. 84-8 5/8/84 Page 4 . . . The subterranean garage wil I be set back 7'-3" from the southerly property I ine and wil I have a zero side yard setback from the northerly property line. Pedestrian access from the garage wll I be from two stairways; one stairway wi I I enter directly into the building the second stairway wi I I exit to the outside adjacent to the driveway. The applicant is proposing a circular driveway in the front yard area. This driveway would be used for loading and unloading passengers. Access to this driveway would be from the northerly driveway serving the rear parking area and would exit 53 feet to the south, A loading area has been shown on the plans adjacent to the rear entry of the building. There wi I I be a 31-3" landscaped buffer located between the rear parking area and the westerly property line. A 51-3" landscape buffer is required by code. The setback area adjacent to the southerly property I ine wi I I range from a minimum of ten feet to a maximum of 24+ feet and wll I be landscaped. The front yard area, with the exception of the passenger loading area and driveways wil I be landscaped, Miscellaneous Information The incl"erator located at the northwest corner of the lot wil I be removed and replaced by a 14' x 13' trash enclosure. In a lettar submitted by Mr. Henry Hege, attorney for the appl icant, It Is noted that the staff requirements wil I be as fol lows: Day shift: Afternoon and evening shifts: Night shift: 13 employees 10 employees 6 employees Mr. Clarlzio also rechecked the Convalescent Hospital Survey which was conducted by the firm of Francis J. Miller and Paul Miller Associates In November, 1977 and submitted as part of conditional use permit request for the Huntington Drive Convalescent Hospital. He has noted that there were no changes to these figures. This survey contacted forty cities including Arcadia; eight of the cities had land density requirements which I imlted the density to a maximum percentage of lot coverage, the remaining cities had no requirements. The survey also noted the parking reulqrements for these types of uses which ranged from one space for one bed to one space for six beds plus one for each employee (see the attached survey), C.U.P. 84-8 5/8/84 Page 5 . The proposed site Is serviced by the Arcadia Water Department. The Water Department has advised us that there Is no problem In servicing this site. In 1977, the City approved C.U.P. 77-32 an addition to the existing Huntington Drive Convalescent Hospital at the southwest corner of Huntington Drive and Hel Iy Avenue. This c.u.p. al lowed 108 beds In lieu of 88 permitted. This project had 39% lot coverage and a density of one bed for each 657 square feet of lot area. Mr. Clarlzlo has received a letter from the Office of Statewide Health Planning and Development (copy attached) noting that they have been issued a Certificate of Need which would al low the hospital a total of 160 beds. Analysis A covalescent hospital Is a permitted use In the R-3 zone with an approved conditional use permit. The proposed 160 bed hospital does not comply with Section 9275.5.3 of the Arcadia Municipal Code which states In part: "the number of beds shall not exceed one I I) bed for each eight hundred square feet of lot area". The applicant's proposal provides one bed for each 589 square feet of lot area, Based on th. lot size a maximum of 117 beds woul d be allowed. . Although the code requIres 80 parking spaces (one for each 2 beds), It Is staff's opinion that 61 parking spaces Is more than adequate to service this type of facility (one for each 2.62 beds). Based upon staff's observations of this site, there Is more than adequate parking, The rear parking area Is seldom used and the 22 parking spaces located In the front have been adequate to serve the needs of the facility Including weekday visitors. As noted in the study submitted by the applicant (verified by staff), parking requirements vary from City to CIty, however, it would be staff's opinion that a parking ratio of one space for every three beds Is more realistic for this type of faelll ty. The applicant has attempted to resolve some of the concerns noted during the processing of the previous application, I.e., they have provIded a passenger loading and unloading area In the front yard area and they have el Imfnated the tandem parking. The new plans provide for a 3'-3" landscape buffer along the westerly property line. Although the code requires a 5'-3" landscape buffer, this area could be Increased to 6'-6" by requiring the car overhang area (39" to be Incorporated as part of the landscape buffer). The minimum 10' side yard setback compiles with the setback requirements In the R-3 zone and the one-story building height Is less than that al lowed In the R-3 zone. This single story addition will have less of an Impact on the adjoining propertIes than would a two-story multiple-family development which would be permitted with a 101 side yard setback. . C.U.P. 84-8 5/8/84 Page 6 . . . I I I , This project exceeds the al lowa~le density established in our code and Is a greater density than the other project which was approved on Huntington Drive. However, the State has approved the site for 160 beds and as noted in the survey, Arcad i a is one of the few c i ties that ha: any I and dens I ty requ I rement. The Planning Department would recommend that the :ity at some future date consider deleting its density and revise its parking requirements for convalescent hospitals. Attached for your information Is a letter from the Office of Statewide Health Planning and Development, a letter from Hege and Rasmussen attorney representing the applicant; a copy of the convalescent hospital survey and letters in favor of this proposal. Pursuant to the provisions of the Cal ifornia Environmental Quality Act, the Planning Department has prepared an Initial study for the proposed project. Said initial study did not disclose any substantial or potentially substantial adverse change in any of the physical conditions within the area affected by the project including land, air, water, minerals, flora, fauna, ambient noise, and objects of historical or aesthetic significance. Therefore, a Negative Declaration has been prepared for this project. RECOMMENDATION The Planning Department recommends approval of C.U.P. 84-8 subject to the tol lowing conditions: ,. Thlt conditions as outl ined in the attached report from the Delartment of Publ ic Works shal I be complied with to the satisfaction of the Director of Public Works. 2. That a modification be granted for the subterranean parking area to have a 0' side yard setback adjacent to the north property line, and a 7' _3" s I de yard setback adjacent to the south property line. 3. That a modification be granted to al Iowa density of one bed for each 589 square feet of lot area (160 beds maximum) In lieu of one bed for each 800 square feet al lowed. 4. That a modification be granted for 61 parking spaces In lieu of 80 parking spaces required. 5. That a modification be granted for 13 compact parking spaces In lieu of 12 a II owed. 6. That the circular driveway in the front yard area be designated as one-way traffi ic only. C.U.P. 84-8 5/8/84 Page 7 . 1. That parkIng shal I comply with the handicap requirements on file In the Building DivisIon. 8. T~at a 6'-6" landscape area (Including vehicle overhang) shal I be provided along the westerly property line adjacent to the residentially zoned property on Cambury Avenue. 9. That a landscape and Irrigation plan shal I be submitted to the Planning Department for Its review and approval prIor to Issuance of the building permits. 10. That a trash enclosure large enough to accommodate two large trash bins be provided and that said enclosure have either a sol id wood or sol id metal gate. 11. That as per SectIon 9215.5.9 al I util itles on the site for direct service to the area shal I be Instal led underground. This shal I Include the telephone pole and guy wires located In the northerly driveway. 12. That al I del iveries made to the site shal I be between the hours of 1:00 a.m. and 10:00 p.m, . 13. That al I mechancial equipment shal I be screened from publ ic view and adjoining properties. 14. That the parking area shal I be marked and have wheel stops in accordance with Sections 9269.8.1, 9269.8.3 and 9269.9.1. 15. That al I landscaped areas shal I be Irrigated and completely maintained as per the plans on file. 16. That fire safety sha! I be provided to the satisfaction of the Fire Chief, 11. That an adequate vehIcular turn-around area be provided in the subterranean parking garage subject to the review and approval of the Planning Department. 18. That C.U.P. 84-8 shal I not take effect until the owner and/or applicant have executed a form available at the Planning Department Indicating their awareness and acceptance of the conditions of the approval. . C.U.P. 84-8 5/8/84 Page 8 . FINDINGS AND MOTIONS . . Approval If the Planning Commission intends to take ~ction to approve this project, the Commission should move to approve and file the Negative Declaration and find that the project wi I I not have a significant effect on the environment and direct staff to prepare the appropriate resolution incorporating the specific findings and conditions of approval set forth in the staff report (or as modified by the Commission). Denial If the Planning Commission intends to take action to deny this project, the Commission should move to deny and direct staff to prepare the appropriate resolution incorporating the Commission's decision and findings in support of that decision. Attachments C.U.P. 84-8 5/8/84 Page 9 . . . Apri 1 26, 1984 TO: PLANNING DEPARTMENT FROM: PUBLIC WORKS DEPARTMENT SUBJECT: CONDITIONAL USE PERMIT NO. 84-8 1601 SOUTH BALDWIN AVENUE This Department has no objection to the subject conditional use permit subject to compliance with the following items: 1. Remove and replace existing P.C.C. sidewalks and construct P.C.C. driveway aprons conforming to City Standard Drawing S-ll. 2. Submit calculations for both the gravity drainage system and the pump dra inage system prepared by a regi stered civ il eng ineer. Computations should show hydraulics, hydrology, and all the details requested on the Cityls "Pump Drainage" sheet. 3. Arrange for utility service and dedicate easements to utility companies. The subject property is served by a sewer 1 ine that has the capacity to transport sewage flows generated in accordance with land use reflected in the City's current general plan to the CSDls system. The parkway width at the site is 13.50 feet. At present, street trees and plants are adequate. Th i s Department wi 11 reserve further comment on the landscaping until more definititve plans have been prepared and submitted. Future plants, such as those planned at the entrance and exit from the subterranean garage and the driveway on the north side of the property, could create site restrictions. tUr); "''1f!~ CHESTER N. HOWARD ~lL Director of Public Works~ CNH:DER:rk . , !~ ~Q z ~ i ii1 At) / 'oS 'SIf'5 . I ... (lf1 ,) 2 J +- Q.' .. ;!! (;70V {/5"247 ,fog ,.. ~K./ I (1f'l2) (/(',oZ) ( ,....10) -r ~ 85.e.T (/~2()) /(/530) J41.2Ci ... I ~4. B'l 0 T:l.40 5O.~e. BALOWI N /40,00 VACANT 00 R'3 +. C /40,00 30 0.00 ~ . ~ ~ ~~ t 2 ..~ ~ - tn ~ - ~ n. ., . .. 1~9,4-0 o 0 ~lJJL5A ~!2--f-g-f\ J C"' -0 p.Z d)~ JOO ________ ------ 300 . CII1'81.8 LAND USE & ZONING o .. ~I . 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CAlIFOIlNIA 9S8U @ (916) 445-1945 APR 26 \964 Date of Issuance: Certificate No.: Date of Expiration: Application No.: ~lay 8, 1984 1222 November B, 83-425 1985 . Mr. Dr1ando C1arizio Pres ident Arcadia Convalescent Hospital 1601 South Baldwin Avenue Arcadia, CA 91006 Dear Mr. Clarizio: This is to inform you that you have been issued ~ number 1222, approved under the provisions of Se~ Health and Safety Code and the regulations pertaining thereto. For all intents and purposes this letter shall serve as your Certificate of Need. Your Certificate is pertinent only to the project described below. The addition of 61 skilled nursing beds and 25 intermediate care beds to a 74-bed Skilled Nursing Facility for a proposed total of 160 beds and located at 1601 South Baldwin Avenue, Arcadia, California 91D06, to be accomplished through new construction to the existing facility. The estimated cost of the project is $1,394,000. In accordance with Section 438.6(b) of the Health and Safety Code, this Certificate shall expire on the date indicated above unless: (1) The certificate holder has commenced the project covered by the certificate and is diligently pursuing the same to completion, as determined by the applicable regulations, or (2) The duration of the certificate has been extended by the State upon a showing of good cause. However, such extension shall not cumulatively exceed a period of 12 months beyond the original expiration date of the certificate. . . Mr. Orlando Clarizio Arcadia Convalescent Hospital Application No. 83-425 -2- APR 2 E ',:04 In accordance with Section 438.5(e) and 438.6(a) of the Health and Safety Code, the undertaking of a project which does not comply with the certificate granted shall constitute grounds for revocation of the certificate. A Certificate of Need is not an endorsement for federal or state financial assistance or for zoning or other local governmental approva 1 for the project. You are also reminded that, should your project include construction, in accordance with Section T17-016 of Division T17, Part 6 of Title 24, California Administrative Code, plans and specifications must be filed with and approved by the Division of Facilities Development before construction may commence. . Sincerely, ~ _/7 r- .I . -, ...., r.r ' Larry G. Meeks Director cc: Licensing and Certification Division - Di str i ct Offi ce Division of Facilities Development - Headquarters and District Office Department of Health Services Audit Section Senator Newton R. Russell Assemblyman 8ill Lancaster . . HEGE 8 RASMUSSEN ATTORNEYS AT LAW HENRY H MEGE LESLIE 0 RASMUSSEN 550 WEST DUARTE ROAD, SUITE <4 ARCADIA, CALIFORNIA 91006 TELEPHONE 12131 <4<47-3538 April 20, 1984 lZCE'V~~ Planning Commission and Planning Staff City of Arcadia 240 West Huntington Drive Arcadia, California 91006 1;1-. - ,.'1.',' 1') ,." " I "~.")4 CITY OF "::"I\J\r...,,-"r~"'CAt)i .. ""r-,', ATTENTION: Donna Butler Re: CUP 84-8 Arcadia Convalescent Hospital Addition 1601 South Baldwin Arcadia, California 91006 Honorable Commissioners and Planning Staff: . Attached hereto is a survey of Convalescent Hospital Land Density and Parking Requirements which was originally made by The Firm of Francis J. Miller & Paul Miller Associates on November 14, 1977. The applicant, Orlando Clarizzio, on April 4, 1948, contacted each of the cities and the county and was informed that no changes had been made since the November 14, 1977 survey. With reference to the parking requirements of staff, the following information is submitted: During the day shift, there will be thirteen employees, four of whom have automobiles. During the afternoon and evening shifts, there will be ten employees, two of whom have automobiles and there will be six employees during the night shift, two of whom have automobiles. It is hoped that this information will assist you in determining that the requested lot density and parking requirements in the plans submitted by Mr. Clarizzio are appropriate and you will recommend approval of the conditional use permit. HHH:df Enclosures Very truly yours, ;./4 t.:.~. . . TI/ F FIII.I! (J/.' FRANCIS J, MILLER & PA llL MILLER ASSOCIA TES 'tiul . I/.~I ,hUll/ill/II, ....'u/l .!Il, II/If~ I (It/l, '"flfo/III/I/!/ .'/L/I..I .' J ~ 111'4'/1 f'"j/, ,r,!li.."I.Jl7 LOS AI1f';P'U:S I AT'< .rfl. I Alh.mnr. / Aros_ 12.1,1 1. l' .1- . '" Burb_nl< / Covin_ .j... 8U'''.8. rf,.y COUNTY CITIES 446-4471 ,Q'-5111 334.16~0 3311 11 ~l 1147-0541 331-0111 R~7-t::"'11 ~ Dnwney ~ Du-rte of' El Monte V C.rden_ v Clend -Ie r Lnn~ lIe_cn ... Lns Anll:eleB 1161-0361 357-7031 57S-2?47 3n-ono 1J56- 2115 51JO-61IJ3 4115- ?3'7 .. T/'IB Anr,@les r."11"tv q74-~411 - T,yo\.lOorl ~'7-01l00 - 1.. P"ente "0-4~1l . .. M'nnrnvi ~ 351J- 3?31 V ">'lntebelln 7"-4100 ./ ,0rYAlk 11611-"54 CONVALESCENT HOSPITAL LAND DENSITI & PI-R\l:lNG SURVEY _~.RJI "'_, I." , .." II . v~c.J ..~ I'{" '_ '-1 - I . (I LAND nENSITI REOIJlREMEl'lT I bed ner AOO sn. ft, lot ,..re- nnne none l1a.J "&' 1 UII!\' li006 Sf". .t '^~ L'II:'_, R -5 ,one - m_x, 70'7. lot cnver_ge by building. none C3 Zone - mAl< 50'7. lot cciver_ge. H-Zone of 71,000 sn. ft, I_nd would .llny 102 beds. none none nnne none none n<1ne nC'lne nnne nnne none nnne PARKINC REOUIREMENT I" beds 1/3 beds. 1/3 beds. 1/3 bed.. 1/4 beds. 1/2 beds. 11,/1 beds. 1/6 beds + 1 for each emolnyee. 1!10oo so. ft. floor .re. 1/3 beds 1/3 beds. 1/2 beds or 3 Sl'.ces /1000 811, ft. grnss floor -reA * 1 sn.ce!500 eo. ft floor At or '0 rn.ce/bed * 1" 11 1/5 beds 112 beds + 1 for eAch fAcl11t, vehicle 1/4ned~ 1/2 beds 1/2 beds t"Avc 'I CQ,Iffl:1F.S,CENT LfI/:1LllENSITY f, '.'ARKiNG SURVEY '. . -ui....".. 511.4?nr. Pt\mn,",,, 6?0-~lnl . Rednnrfn Bp._ch 37?-1171 Rnseme_d '111\-6671 S_nt. M<>nic. 393-.9975 Snuth p_s_den. 700-9101 S.n C-brie 1 '11'-4104 S_n Dim.s 59<)-6713 Tem"le City '-113-3314 West Cnvln. <)6'-1\631 ORANGE COUNTY CITIES An.heim 533-5657 Buen- P_rk 5?1-0900 Bre- 5'9-4051 . Cnst- Mes. 556-5?4~ Fullertnn 5'6-7171 Corden Crnve 631\-6661 HuntinRtnn Be_ch ~36-5'41 Ne"","t't Beoch 640-"10 Or'n~e 53'-0415 Or.n~e Cnll"ty 1134- '6'6 Pl_centl_ 993-Al,7 S_nt_ An_ 1134- 4164 . * ~lch~ver Is the ~re.test t/3 bod I m" 4S," bld~ ota" enYet"~. nnne none none rt2beds 1/1 hp.rfs 1/1 heds 1/2beds R4 Znne - m_x 501. lot cnver_ge none none nnne none 1/3 beds + 1 so.ce for e.eh em.,lnyee 1/3 beds 1!3 beds + 1!5 beds fnr visitors & emolnyees 1/1 beds mox 507. bld~ .re_ cnver_r,e 1/' beds none "noe 1 c_r!1000 so, f~, of gross bld~ .re_ 1'1000 sn ft f1nnr _reo or 1!1 beds * 1'3 beds m.x 501. lClt cnver.~e none nnne n"ne 1/1 5 beds + , s"oces 1'3 beds 1/1 beds C' 501. m.x bldg cnver.~e '/3 beds none none "nne nnoe none 1/3 heds + 1 s"_ce e.ch em.,lnyee 1/2 berfs 1/4 beds 1/1000 sn, ft. f10nr _reo or lI?beds * 1 c_r! 2 beds or 1 for e.eh '00 Sn. ft. slog. t'm. Survey m_de & "ren_red by /34~ ~11 Miller Miller & Miller Associ.tes OUR SAVIOR LUTHERAN CHURCH 512 WEST DUARTE ROAD' ARCADIA, CALIFORNIA 91006 . (213) 447.7690 REV. ROGER R, SONNENBERG. Pastor. Res, 445-8613 . March 19, 1984 DepartIrent of Health Sacramento, California Ladies and Gentlemen: Mr. Orlando Clarizio built and operated Arcadia Convalescent Hospital and other facilities that he CMl'lS since 1962. During this tine tixlusands and thousands of Arcadians have gone through the doors of Arcadia Con- valescent Hospital, reoei ving the best care available. In the last ~ to three years many Arcadians, including sore of our rrerrbers, seeking care at Arcadia Convalescent Hospital have been turned dcMn for the lack of beds and therefore, forced to seek distant, as well as less desirable accorrrrodations away from their loved ones. . Mr. Clarizio is now seeking to build a one hundred bed addition consisting of skilled nursing as well as intemediate care, in the hope of providing the necessary beds desperately needed. I support this project and hope that the autixlrities in Sacramento allow it to be built. Sin~ly, ~ ' / / / . -4~~~ . ~ 'Pastor ~ Sonnenberg (// V v RS:kb . . A' ... T"'otr~ 'J\f, '~I\ ~~ ':f,../f "':tp.~~--, . ARCADIA CHAMBER OF COMMERCE l81\\..'~' '~l.....1)'..., 10"', DRi\T PO BO\:8(,~ A.RC~D'~ (A,:lr-OR",,'\{jL~," - ~'.1 4J.-,215~ March 16, 1984 Department of Heslth Sacrsmento, California Dear Sirs: I came to this City of Arcadia in 1962 and have known Orlsndo Clarizio and his family since that time. My vocation st that time was in the Funeral Industry and as a result I was well aware of the operation run by Mr. Clarizio. In dealing with the families that hsve lost a loved one they spoke of nothing but the fine care they received at the Arcadia Convalescent Hospital. . At the present, I am the Executive Vice President of the Arcadia Chamber of Commerce and our recorda indicate that the Arcadia Convslescent Hoapital is in good standing. I trust that Mr. Clarizio's new proposed venture of expansion will meet with your favor. Sincerely, %~.C.~ Kelvin C. Mason Executive Vice President . . . . t METHODIST HOSPITAL OF SOUTHERN CALIFORNIA 300 WEST HUNTINGTON DRIVE. .ARCADIA, CAL.IF"ORNIA 91008 . (818) "<4!5-~1 RICHARO A HACHTEN, II PRE51PENT Ar\lD ADMINISTRATOR Orlando Clarizio Administrator Arcadia Convalescent Hospital 1601 $0. Baldwin Avenue Arcadia, California 91006 Dear Mrs. C1arizio: March 22, 1984 We were pleased to learn of Arcadia Convalescent Hospital's efforts to add intermediate care beds. The Methodist Hospital supports the increase in beds at your facility. We hope that the added beds will help to alleviate the shortage of available ski1.led nursing and intermediate care beds that we are ex- periencing in our service area. ~H:nb A COf.H'~~lf ~~ (' ',' . 1...::1- Sincerely, , . nlJ:fl;/!/(j::4~ rv"",1lor u 1'\. ptH.lll.~r1, 11 '- .?p~side~~nd Administrator ~ \ 1: ~ THt JfJ!NT Cu.',". :-5!0:. CH. AO:C~EOiT"'T[Or': OF HO~r>I'TA. S / . File No. /.//,,-O,p4 - ~ CALIFORNIA ENVIRONMENTAL QUALITY ACT NEGATIVE DECLARATION CITY OF ARCADIA, CALIFORNIA A. Description of project: ~/7/?7~';N /../.('~ rk::.77~~ 7Z> ~/A , ~ I!EX~JSC- ~lA6/~s=;t;:,-_~~ .,1?L?;1/L. -~~~ 7'-;~ 77J /~ g~ B. Location of project: /hO/ S. ~4//,u' Av.tEijUV,€ . C. Name of applicant or sponsor: ~/A-2/~ /'l~./.i":) D. Finding: This project will have no significant effect upon the environment within the meaning of the California Environmental Quality Act of 1970 for the reasons set forth in the attached Initial Study. E. Mitigation measures, if any, included in the project to avoid potentially significant effects: Date: ~B/M ~ l.gnature ' . Date Posted: ('1SS,Q;;/An:;, #A'ZA~ Tl.tle . . . File No. r"r"rp """ A_p" ENVIRONMENTAL CHECKLIST FORM A. BACKGROUND 1. ~o= L/A?IZ/z/&> Name of p~oponent 2. Address and Phone Nwnber of Proponent /~~/ 5. iS4/ ~.<G/,.......u- M~?L?RI, a ~t5'~.?/?t? B. ENVIRONMENTAL IMPACTS (Explanations of all "yes" and "maybe" answ.rs are required on attached sheets.) !!!:!h. W111 till propoell .......It In' .. Unltdll, ..nll eondlHonl or In o:hall'l',.lnqeoloq1elubltructllr..? !!! ~ .!!Q. ,/ ,,/ ,/ ,,; ,,/ ".. ..... ~ ~ ~ ,/ ,.... V ".. ,,/ L' ../ Subatll\t181 d.phtlon of any nonnn.....ble nltural ....ou..".? ill ~ !!2. 1\ Subltanto.J r.,<luctton,nth", llIOUI\ t ,,~ ... tey otl\........ 1 Ie IV'" i Lob 1.. !or pub)'" "H." luppll"'~ v l t~lK'.ua"~ ".."pi.. or prop"rty tOWH.... r"lated .....rd, 1\1"''' II '\oo<'hnc' b. DI....upt.Jon., dllph"...nV.. cc.. p-cUonor o....reowrrlnq or th" 10111 C 0l1ft911nt0pcl9rlphyorqrOund lurf.". reli,t hltu..,,? -- ~1oIIl1th.propo..lr..ult ~ Chlnqe ,1\ tll.. dlv"rnty of _peel" ~r nllN>e. of .ny .~cu. or planu (:nelU~ln" ~r"'''.. .hrubl, qr..., erop... '!'lll:ro'~or' .n~ Iqllu.ic pl.nt..'? d. Th" d".truct1on, COVllrin'lOr ~Ulut1onof .ny W1iqu.,--,loqH orpl1ydca1 tut.llr..? .. Any Iner.... in ..inc:l Or ....tar "ro.Jon ot .Olt, dtl1"r on O~ off tl1" "H.? b ".."..ctIOI\ o! tl1" n.....n of any 'J1IIq...., r.reor..nd.nq..ud.pecl.. of ~hnt.' L f Ch.lI<j''' In U1Ut101l, depO&iUon Or .rouon ...1\1el1...y a:>dUy tl''' el1.nn.lof.rl""ror.tr... c :ntrocl...ct.lonofn......p.cl..ot ;>hnu L~t<, .1'1 "1'''., or r.....lt In' ".rr,'" .. '.~" ~.~r".l r..p1enl.~nt "f ..,j". ~c opeC'l"" -- ~. KllpOIIure of ~oph Or proptlrty to 1.0109i" 11...rd. .uel1.. ".rt(lqu.k".. 1e...hUd... ...d.tlldu. 9'l'OlInd failure. or .1ail&rl1..ud.? .....11l.1 ~,f.. loIill tl1. p..opo..1 ....1I1t ..' !l:!.. Will the propoul ....ult 11'1' a. '.m.e.nUd &ir ..Inion. Or 4&t.rionUon of __l.nt &1.. <fll.llty? Chong" ,1'1 the div.raity of .ped... ornlll"\l'!.r,ol.ny.plel..ofenl..I. {bird., :.nd '1'11..1& lncJudlt\q repUl... fi.hlnd'he1lti.h, b...tMeorq...I..... .n..eta or ,.,crot.un.11 II. Th. cu.Uon of ob,.euon,o.bl. <"don? t> keduct1onofth.n~r.of.ny ",nlq...,r.raorand.nq.r.d.p.e1.' ot.nllll.l1&1 <' Alt....tionofur-.ov_..'-' "",htllr.or tMllp&Ut..r., OI .flY chanq. 1.1'1 cUaeta. .ahu 10c...11y orr..,lon.11y1 "!!!!! Ifl11 the propo..l re."lt In' Introdllct1onot n"'.p.ciuof '1'1...11 ,ntO.n .r.a. <II' ra'1I1t in . b.rtl..rto th. ,"qr.tion 01''''''''- .....nt -:01 .nu...1&? :I. Oat.r1outiont.o.Il1.Unq..Udl1f. lIaba.I' a, Cl\ANf.' in curr.nt. or tll. cour." ofd1...ctlonol...t.r~_ntltn fr..h...t.r.? Ifot... \01,11 the propoul n.ult In' lncru,." 11\ ..1.tln, 1'101.. 1....111 b.Ol&nq..ln...".orptlonrat.... dr.in.q"patt.I'Tl..ortherat...nd .-elmt of .urtae. ...tll' n>nofP t>. ".po.llre of ~oph to ..ven nOli.. l.ve1&' c. Alt....t.1.....toth.eour...oI U"", of Uood ..un' ~~~~e:n~~l~~:ht :~1~1~~:1PrCopO..l d. Cban,.lnt;I1.-..tol."rf.ca ....tar 11'1 IIIlf ..It.r body1 .. 01.c1'l.I'9. lnto .urtae.. ....t.n, Or lnllny.lt.r.tlonot.urf.ee....t... qU'lIty, 1l'lCludln'lboiltnot l1"'ltedtO l~.ut.ur.. dh.ol..edo-.yqe~or t..rbtdlty~ I Alt....t.lon ot the dlrect"jr, or rat.. of tl""" of 'lrt>un4 ...t..u~ 8. Land Un. '01111 the propoul r..ult in ~nt1al.lt.nUonofth. pr....ntorpl.nn..dl.ndu.a.ol.n.r..1 9. Nat..r.l It..ollrcea. ifill th. propo..i r..,,1r In' .. :ncr.....lnt.h.r.t.otu..ot...,. n..tllr.l re.oure..1 , :h.nq..ntl1.qu.nUtYo!'r....nd ".t..... uther t1'll"O"'9h direct a4dlUon. or "tth<lr_al., or thro"'9" lnt.re.puo" ot.nyaqllit.rbyC1lt.or..xc.v.t.I::>n.? -1- . . . " RI.... at ~PSl!t. ~"... '~e p~"p<l.~1 lnvolv", r,"kof an <'xplol>O" "r the eele"." o! "uar~<'us aubU.."cu IlncludU',,~, but not l...ned to, Oll. p..ticl.d"l, ch."..c.h or :"dlatlonl I.fl, th.. ""..nt 01 ~n .Cl:H....'" o. lJP..t condluOI\a, u :fr:U ~~~~~n . w ~: ; t ;~;u ~ ~~~.:~n: : ~~ ~ "T qr<N'th rUe at" ,1'1... ~u."'~n popul~. , io~. of ,,, .r"4~ " ~~~:~~~~ h~~~~n:~" O~f~~;:~~ :I!.." de'..nd tor additionsl houdn<;~ L}. Tranloort,.;ltlon/Clrcu}atlon WIll ll'lepropon..lr..ult ,".' .. Ge"ereuon ot !lIbatan,J..l uldl- ttonel ""..,"ul&._""",,,,,," " Err"cu On ..sating plrli.1n9 l.r,HtlU Or d.....nl\ fen n"'" pn"'lno~ Sub.tant..l ".p.ct upon ..xuUno tu".portat1on .Ylt_' d.1lttera.,onltopr"."ntp.t,..rnl ot<'lr<:>l.la.t:.onoreo"~ntot\l,,o\lh. .nd/or'lOo,"-' .. Alterluonl ,"..It..rl>orn.. ra,) or ur tc..H,,,- f lncre.... '" tr..UtC ~....rdl "'Otor ve~'rl.,~ bleydllt~ Oc pe<lenr1anl' " Pul;Jhc S"rv",u IIlII t~" !lrGi'o..l h..va..netltctupon. Or re.ult inl ne..<l tor n... at ..ltere<lqo_rn_nt.l 'u'vle,," I" In" '>! tl1" !"ll""l.nq u.... rtn prot.et,nnl Poli~ pr"t'"~',on> Sehooh" d. Park. Or oth.r r..::ren:lonll hulltl..? .. Matnt."I"C:1 ot publ,e h"lll' t1u.lllc:llJdlnqro..<l.? t. O1:J\er 9OV.rllI..nul ..rvic:.a? I ~ !!'.l!!Jl. "ill the proPo..l ruul t ~n, I. U.. ot '~'Unt1al laOuntl nf tHlorell'rqy? b. aub.t.nt1.1 lnen.... In d.~.nd upon .xl.f.ill' .enne.. gt .n'rqy, or requirethotd"v,-l~lltotn'" tourc:..ot.n.rqy? U. Utiliti... 11'111 tll" propolll nnlt Iii""'i""iiiitorn....y.t.....or '\1!).tanHd Ilt.ntion. to tile toll_. In'J utilitie.: P......r or IIlturll ..u? b. C:_unl"..HOI'lllyft_.? c. Ifater ~ d. S","rora.ptietankl? .. Sto.. wat.r drain.'Je? t, Solid wuta Ind di'poIII? 1'- Hue.." Hulth. Will thl propo..l r."nt In, .. Cr.tHonot .lny h.IIth hnard-or pot.nthl 1I..1th IInard 1...cludin9 ..nt.lh.aIthl? b. &xpo.IU" ot people to pot.ntill h..ltll hu.rlb1 Date ~4/~ i!-~': ~Y.H.l 0/ '" ,/ .i. 7 Z ,/ ,/ .L lL L L L .L v 7 7 :; " ~,,"t~"t''',. ~l II the propel,al to..\.!;! ~..~"~tlo"ofany.e,,nlc ...hta 0' v,,,,. "'pen to the publie. or w,lltheproPD"alrnult Lnth,. "r.,..tlon of an a..th.tle.l1y offenu'" HIe Open tn pLltllle vioN? ttS MYEl! ~ L " ~"ete..tlon. w,\1 the propo..al r,.,ult In.n.....ctuponU,..q....lllynr _lu.ntlty of exi~tinq ..er..t,on.1 opportunltl...' .I '" ~~~:~~~~g~;:~{~l~~o~~e:~ ~~.~~~~n t~~ l .., "nl' 'c'1~' ~tetleolO'ille.l Or ',1' ,e .... .truetu.". ClOJeet ", "-llld\'L .!L ~~nd~~ t~~r_~~~5:e~f h~~:"~~~C:::~:~tlal '0 <l"gud,. the qu.Uty ot the en..lron_nt. ~ubn.ntl..llv r..duc. the hlbit.t ot a ~I..h or '~llrl;de Ip.ciu. cau... . tHh ." ...il.'llt. populatlon todropb..IOW' ,~t' -_-,~...I"'flq t..v..t., thr..aten to '"1-.',,''' , pl.n~ 0' .nl...l co_unity. ...,,,t.' ',~~ flu'ft,..r or r".ulct the unq~ "1 ' _".. "'r end.nqered phnt or .nll..1 " ";,"',n.-' ''''Portant e~a~le. or th~ .....J'H p"r.od~ ,.! o:::..llforn>a ''Il'tory " 1,'''hl~tO''I- 4' : Oo..~ Ih" pro):eet hav.. 11'1.. pot..nn.l 19 ~el'l,..v~ aho'" t..rtl. to t~.. dll.d-v.nt.ge of 10n'~-,-"nI' ..n...lron....nul go.I~? (A .horl.l'.r..''''P.c.onlh....nvlr_nl II o)nrwh>eh"Ccu.. In. ,..lotlV.ly ....,.t <l..hnltl-'" I''"'''''"! ot -i_ wl'l,l.. l~n"-'"'' ''''D'C[' '" J' ~nrl,,'" w,.,: Into ''''- ',,-.,. .t Do... '1'1.- pt.-,)"Ct ".v.. >"'P.CH "n,chare ,orl,vldually ll",it..d. but ,-"""'\U"'''~'t Nln'Ho"..bl,,: '~I'r<)l"e~ ....y ,tlp.c' "r. l~o nr moU ...pacate ,,,.ource. ..here tn.. l""I"'c~ on eaCh r..."u.e" " r..l~li'Jlly ......1[, t:ut ..~<tr. tl'l.. eft....t "t tn.. tlltal of tho'" ll1p.cU on rh.. p""lrafl/ll.@n' '" ..lqn1f'<'~nt _, .I d. Doe~ the pr"J~ct l'Ia"'~ en.... re",..en'.l ~tr.eta ~1'I1<:-I'I ",,: ".u.~ .l>b.tanti.l .dv..r.,. ..!! ..ct. "'\1'1 .~,,",.I'I D..l ng~ ... th." JI.tlell", "r .,,(llrpnl\" / DlSClJs~:n1< :'If P;V'PG>~~.1:~TAI_ r.V-'l.U.l.':'rON DtTtJUO.IN-''rION Itob.eCltlPlet<tdby the Le.dAq."eyl Dntl'l.b.....ofth1.1n1tllllv..l.u.tlt>n' 01 ttnd tll. prQpa..d projlllct COULtJ -.oT h.lva . d'JniUoaat .Uect on thllllnvlron_nt. .nd. NECATIVE D!Ct..\UTIllIf wl/l boo pr.p.r.d. OJ !ine! th.t .1thOllQh the propt>ud proi."t (!ould h.ve .. .t<;ln1Heant.tteeton th...llviron_nt, t1ler.will not t><I!. "<pI1H".nt .H..ct In thit ene bec.~e t1\. .itlfat101l ......ur..' d..er1b.d on .n .tt.eh.d .heet h..... been .ddotCl to tl'le proJ..ct. A NEGATIVE DECLAlUoTIOlC lULL liE PUPIUIEtI. 01 llnd tile propa..d proJ&ct MY h.ve. dqrl1Hc.lnt .U..:t: on the "nvl.ron_nt. .no:! ..n ZIN1Jta.l'IE1ftJIL llO.a.CT 1t!.1'()W'l' h r.quir..d. ~~ S' ature) , -2- . [.U.P. 84-8 . . 6a. The addition of approximately 90 beds could create an additional amount of noise generated by the increased traffic. The applicant is proposing to relocate the driveway to the north side of the lot away from the single- family residences to the south. Also, parking will be available in a subterranean ~ara~e which will limit the noise impacts from parking. Generally speaking, a convalesc'ent facility does nnt generate a high traffic volume. IJb. The proposed addition will require more parking, however, the applicant is providing ont? ra rking spaces for everv 2..7 heds. Ill, There could be a possible increase in l raffi> hazards due to the increased traffic. The bu(\<1in~ i" "etback 40' tr,'m tl10 front property line. I.and- scape plantin~ should he kept d maximum "f ']' Ln height at the front setback t(l avoid obstructing visibi Lity. 141, The increase in the number of beds ,"ould create an increased demand in the paramedic services. However, the Fire DepClrtment has indicated this \1111 prohabl~' be an insignificant increase since there are trained nurses on duty. . File No. Gur:'A4-~ ENVIRONMENTAL INFORMATION FORM A. Applicant' s Name: Ce.UhWo LJ-AK.\L,"') Address: ibO' .>0 t At.-p\t-".,. ~V . IbOI ~o ~A-L.Di-(//f'f It-v, 1t~C-'1 0,':\ Lit l.. ri DD b e. Property I\ddress (Location): O. ZOne Classification: 1J! 0 L T I r'l..;:: Q.-:1" 'f'(Jt11'-i C. General Plan Designation: E. Proposed Use (State exactly what use is intended for the property, l.e.. type. activities, employment), 1::.1 P4t1>Il,)~ l-lo<;.f'l~L :tRol"l Of 71..1 fj .sp (0 .-- , ( "'11: ,oiAL Ot: I !-' ,0 r.:: ( 15.1. r14 C 0... /l ,.. r " . nV~1L"'.>Lc:r-fI'; t-t o II' or-! . , r1 \Z. . D v' c ,z f!a..r:::,t-I c. -:1'0'- 70 (;,,; >'1'/4-/....' :>Tr,i-- - ") ":' I .....,' ~ t_ 1/00 IS eo~ c.0f'f...l:TIZ. otic )'-1 Lfvl:L Dt Pltf2.I,111... .soje,~.:O...fl.HI=A~ (,1+i.5. (PitR.T1ItL 3AS'::M~HI) o,'-t 13q .s.,r -:t-r. F. Square Footage of Site: G. Square Footage of Existing Buildings: H. Square Footage of New Buildings: Iq 00 D .-SC( -- oj- I. I ,000 J.;~ yOa 1. To Remain: 2. To Be Removed: I. Square Footage of Buildings to be Used for: 1. Commercial Activities: '-J2..J-joo 5~ t', 2. Industrial Activities: - 3. Residential Activities: - Number of Units: - 1. On a separate sheet, describe the following: . 1. The environmental setting of the project site as it exists. E....S'(,rfG. col'tv. Ho.>P, _I ~,\DL-! <'1r;: J c 0,",57(., 2. The proposed alterations to the project site. ~~LAllc.-"a. t."'\,,.(, CO,.{v, i.l,,~r, \ >lolZ.'1 'l',/i'6 V c o~~TIZ_ 3. The use and development of the surrounding properties. G- 0 M r<"", t. c., A 1. D. riD R "" .s q) ,: '-Ij', A L -f- ~ Environmental Information Form K. Check the appropriate answers to the following questions: Yes No 1. will the proposed project result in a substantiai alteration of ground contours and/or alteration of ~xisting drainage pattern? vi 2. will the proposed project result in a change in groundwater quality and/or quantity? J 3. Will the proposed project result in an increase 1n noise, vibration, dust, dirt, smoke, fumes, odor or solid waste? / 4. Will the proposed project result in th~ use or disposal of potentially hazardous materials? V' 5. Will the proposed project result in a substantial increase in demand for municipal services and/or energy consumption: 1/ Explain in detail any "YES" answers to the above questions on additional sheets. L. Provide any additional information which would elaborate on the potential environmental consequence3 resultant from the proposed project. . M. 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 and belief. Date: ~ - iL- 11 '6 u ~\~ ~'" - Signature of Applicant . -2-