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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 X PROPERTY OWNER X AGENT OF OWNER <br /> Name SE;i C, / P/" Sla-54 , <br /> Address 7Z <br /> City <br /> State/Zip G G� <br /> Phone :E - <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval , <br /> QZone Variance, Other : <br /> 2 . Project location: 0 '?(5 C, \-k 1-26tr27' )W 14Gel-Z22 kp O <br /> Describe the project; i .e . , request being made an nature ofd <br /> Identify specific project components : <br /> 3 . Total acreage of project: �Z,o # of existing parcels : <br /> Assessor Parcel # ( s ) : 00 5 — 17C - 01 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : /Vo <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />