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1 <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 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 ,3��,,,6 , �zz <br /> Address_ <br /> City Lam, <br /> State/Zip e- - - 942 0 <br /> Phone 3GB- Ge,i B " <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, [] Major Subdivision, <br /> Q Zone Reclassification, X Minor Subdivision, Q Site Approval, <br /> Zone variance, Other : <br /> 2 . Project location: ldllrnx <br /> Describe the project; i .e. , req es? being made and na ure of use. <br /> Identify specific project components : ,��ucrla,l,! eXis74 <br /> 3 . Total acreage of project: 53. 3 ti4� # of existing parcels : <br /> Assessor Parcel # (s ) : <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 /> I <br /> I <br /> 17 - ( 8/86 ) <br />