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Environmental Information Form <br /> Part B <br /> DATE : 19Q <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 XX PROPERTY OWNER AGENT OFj OWNER <br /> Name Gary & Marilyn Dildav _ <br /> Address 1254.5E Harney Ln <br /> City Lodi <br /> State/Zip Ga. 95240 <br /> Phone 209 3 9-51 209 9+88918 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Major Subdivisicn,. <br /> Zone 'Reclassification, [] Minor Subdivision, Q Site Approval, <br /> Q Zone Variance, Q Other: <br /> 2 . Project location: 2840 and 2850 Loomis Rd. <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific. project components : Vehicle Towing and Storage Service <br /> Famed gravel ed -a+ora ge v^-a a ryl -m M l ffi a <br /> 3 . Total acreage of project: Two # of existing parcels : TWO <br /> Assessor Parcel Us ) :: 17Q loo-04 and 129_1 no-n5 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: none <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: none <br /> PERMIT AGENCY <br /> Site Approval Application - 5 - ( 6/86 ) <br />