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Environment6, 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 zaY4i['-r 1:2 ale <br /> Address 7,S¢ Shah V :✓� <br /> City --S an G'r► / r�• <br /> State/Zip SA O <br /> Phone Zo 952- G2GZ- <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit , Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval , <br /> Zone variance, Q Other : <br /> 2. Project location: Cl�ir1�2junsoic .Til GXu� �-f�a�'' <br /> Describe the project; i .e . , request being made and nature of use . <br /> Ident ' fy specific project com onents : G — s Gohsis i <br /> 3o v Q ' e /.' t o <br /> S � s . ' d� •.,.. c . <br /> 3 . Total acreage of project: :5: 12&- # of existing parcels : / <br /> Assessor Parcel # (s ) : 0/3 - /60-- /D <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : AJo -I-c_- <br /> 5. Other.. permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> A40/ <br /> I <br /> Major Subdivision - 7 - (6/86 ) <br /> i <br /> I <br />