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Y <br /> =4 Environmental information Form <br /> - Part B <br /> DATE: <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 1/ PROPERTY OWNER AGENT OF OWNER <br /> f Name `--+ <br /> Address <br /> City <br /> State/Zip ,1p T'7 <br /> a Phone - % 2- <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application:'X <br /> Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> x Q Zone Variance, Q Other: <br /> 2 . Project location: 'Snd6 " _ Co ,g- 22-0 <br /> Describe the project; i.e. , request being made and nature of use. . <br /> Identify specific project components :_ -To 1ikL6; <br /> 3 . Total acreage of project: 0•`1 # of existing parcels : <br /> Assessor Parcel Us ) :: _b Z_ <br /> 4 . If there is an existing EIR assessing an 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 /> 12, - ( Ak ZF <br /> • <br /> Use Permit Application -- 7 (6/86 ) <br />