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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 PROPERTY OWNER AGENT OF OWNER <br /> Name_ .Sl <br /> Address ;F 7-61:V X10 . `WZG4ieFiitAV <br /> City STOc,erdN <br /> State/Zip aA 9sla G <br /> Phone y 2-19 ¢05' <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: ® Use Permit, Major Subdivision, <br /> [-� Zone Reclassification, E] Minor Subdivision, [ ] Site Approval, <br /> Zone variance, F-� Other : <br /> 2 . Project location: <br /> Describe the project; i .e . , request being made and nature pf use . <br /> Identify specific project ,,ss��mponent- : D B zKd f�rc <br /> 0ei�s -V f �ra= h�a.,c vim..-, G r5o !G e s s <br /> 3 . Total acreage of project: -9. 3 S of existing parcels : <br /> Assessor Parcel UsY : /75 ^Z/ — c <br /> 4 . If there is an existing EIR assessing any aspect of your project J <br /> site , provide title and date : /1/p <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT // AGENCY <br /> 6ia�,o yGv+lc f�s�✓cc �T.aTE OL ������r"'-� <br /> Use Permit Application - 7 - (6/86 ) <br />