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Environmental Information Form <br /> Part B <br /> DATE :SQ,d �i e9 <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 k"'.'AGENT OF OWNER <br /> Name 1iC'/ Z�) 'I'aIAKlG <br /> Address 7540 .Shoie/;nom Vi;✓� <br /> City �TjDG.�' an C� /r�• <br /> State/Zip SZ p 1 <br /> Phone �7og� 952- G2G2- <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit , mun Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Zone Variance, Q Other : <br /> 2. Project location: �Cprn� _ jGw�s/c JY GX71��'iv� <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project com onents : G — 40 Ir Go--,X :•7 <br /> C <br /> 3 . Total acreage of project: S / fA # of existing parcels : / <br /> Assessor Parcel # (s ) : 013 - /By- /D <br /> 4 . If there is an existing EIR assessing any asppect of your project <br /> site, provide title and date: -U<-- <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> �J�r�i� S✓ 00 .c <br /> N <br /> Major Subdivision -' 7 - (6/86 ) <br />