Laserfiche WebLink
• 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 <br /> Address Itoo D6W�7 D \/ o !0 - <br /> City <br /> ' -City d PtH MLA �� oC <br /> State/Zipr-Aqt,-23737 .ZJ <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Site Approval, <br /> Q Zone Variance, Q Other : <br /> 2 . Project location: Z+4 10 S (�� �1 . <br /> Describe the project; i .e . , request being mace and nature of use . <br /> Idgntify specific projec com onents : A. GLj L U I L <br /> ,hstd 1� : t, Nva L W & <br /> 3 . Total acreage of project : 4v, oAG� # of existing arcels : <br /> Assessor Parcel us ) : <br /> : <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 /> G 1 61 LPI Q CA <br /> CU 112'L11c i? <br /> Site Approval Application - 5 - ( 6/86 ) <br />