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Environmental Information Form <br /> Part B <br /> DATE : S IJ.faR SSS <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 <br /> Name fyNL.7p� ?�' , �t7�i S <br /> Address S44% voDLEFieLa <br /> City rre.E Mo�T <br /> State/Zip q <br /> Phone (d,s 6S-? - -294Z- <br /> A. <br /> 942A. PROJECT DESCRIPTION <br /> 1. Type of application: E Use Permit, F--J Major Subdivision, <br /> El Zone Reclassification, 0 Minor Subdivision, Site Approval, <br /> E] Zone variance, F-� Other : <br /> 2 . Project location: Lita JE QAC <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : P2ov-ose <br /> M R VbA-T /SPP P-�D A e to �A-r'4 <br /> 3 . Total acreage of project: 33.4 # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 253 - i zo - 4Z <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: 000 G7 <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> Use Permit Application - 7 - ( 6/86 ) <br />