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Environmental Information Porm <br /> l 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 6 . �' <br /> 4 IPA- <br /> Address / <br /> City c <br /> State/Zip ^ 3 <br /> Phone u _ <br /> A. PROJECT DESCRIPTION <br /> 1 . Typc of application: Q use Permit, Major Subdivision, <br /> _ 3 Zone Reclassification, D Minor Subdivision, Site Approval , <br /> Zone Variance , E] Other : <br /> 2 . Project location: /0 ) 3 4 ay_ 4, z <br /> r)escribe the project; i .e . , request being ma,6e and nature of use . <br /> Identify sl; cific pro 'ect components : <br /> f� — CUccrv4 <br /> / <br /> c� <br /> 3 . Total acreage of project:_ r of existing parcels : <br /> Assessor Parcel (s ) : /Il �2 /Lg— <br /> T <br /> 4 . If there is an existing EIR assessing any 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 /> � -o �� roval Application - 5 - <br />