Laserfiche WebLink
Environment6i Information Form <br /> Part B <br /> DATE : 2 /7 l9/ <br /> (To be Completed By Applicant) <br /> NOTE : In completing this form, use additional sheets if necessary. <br /> Answer all questions to the best of your ability. If a question <br /> is not applicable to your project, write NA (not applicable ) . <br /> Please do not leave blanks . Incomplete forms cannot be accepted. <br /> PERSON COMPLETING FORM ✓ PROPERTY OWNER AGENT OF OWNER I <br /> Name .57'.G <br /> Address <br /> City ��tac� T.✓ / <br /> State/Zip <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Use Permit, PIajor Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Site Approval , <br /> Zone Variance, Other : <br /> 2 . Project location: �,rj .574 Sm4 ,S�ac�/o•� <br /> Describe the project; i .e. , request being made nd nature of use . <br /> Identify eci , pr ject co ponents : <br /> O , <br /> i <br /> 3 . Total acreage of project: `I�� # of existing parcels: / <br /> Assessor Parcel # (s ) : /77� o — yy f <br /> 4 . If there is an existing EIR assess' g any aspect of your project <br /> site , provide title and date : <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> f <br /> Major Subdivision - 7 - (6/86 ) <br />