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Environmental Information Form <br /> II <br /> Part B <br /> I <br /> DATE : JULY 31, 1989 <br /> (To be Completed By Applicant) j) <br /> NOTE : In completing this form, use additional sheets if necessary . <br /> r <br /> Answer all questions to the best of your ability. If a,lquestion <br /> is not applicable to your project, write NA (not applicable ) . <br /> Please do not leave blanks . Incomplete forms cannot be:liaccepted. <br /> PERSON COMPLETING FORM PROPERTY OWNER X AGENT OF OWNER <br /> I <br /> Name EDWARD GROGAN & SCOTT MALEK I <br /> Address 2415 LUCILE AVENUE <br /> C i t v STOCKTON <br /> State/Zip CALIFORNIA 95209 jl <br /> Phone (209) 477-7081 �. <br /> j A. PROJECT DESCRIPTION I� <br /> 1 . Type of application : Xl Use Permit, Major Subdivision, II <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval , <br /> i <br /> Zone variance, Q Other : SPECIAL USE PERMIT !� <br /> i <br /> 2 . Project location: 1981 CHEROKEE .LANE STOCKTON <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components - RESIDENTIAL CARE FACILITY <br /> DESIGNED TO HOUSE CHILDREN WHO DUE TO CASES OF ABUSE AND OR NEGLECT ARE <br /> UNABLE TO RESIDE IN THE HOME OF THE PARENT OR GUARDIAN. II <br /> 3 . Total acreage of pro.ject:APPROX. 4 # of existing parcels : III <br /> Assessor Parcel '# ( s ) : 119-150-34 I & II & III p <br /> i <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : I <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : !i <br /> J <br /> PERMIT AGENCY !I� <br /> NONE NEEDED (STATE LICENSING) 1 <br /> u <br /> II <br /> � l <br /> i <br /> Use Permit Application - 7 - i ( 6/86 ) <br /> E <br />