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Environmental Information Form <br /> Part B <br /> DATE : I C1 0 7 <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 V AGENT OF OWNER <br /> Name n rYi O vt rZe et' <br /> Address. m CM")OAe O t tZk9 a t^ <br /> City bAI- <br /> State/Zip d-41 -j 2 <br /> Phone .o 7e/:5 .?37 7 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit , '" Major Subdivision, <br /> Q Zone Reclassification, Minor Subdivision, Q Site Approval , <br /> QZone Variance, Q Other : <br /> 2 . Project location: ayc 1 � D �� <br /> Describe the project; i .e . , request be91m,1'e <br /> made and nat re of use . <br /> Identify specific project components : Iq /(cr-s '1V1+o <br /> 'Fwe Ism . <br /> 3 . Total acreage of project: � � # of existing parcels: �— <br /> Assessor Parcel # (s ) <br /> 4 . If there is an existing EIR assess ' ng any aspect of your project <br /> site , provide title and date: k_,R <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 />