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Environmental Information Form <br /> Part B <br /> DATE: �— 9 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 AGENT OF OWNER <br /> Name! L�/7 <br /> Address 2 2� <br /> City <br /> State/Zip 01-,r10 6 <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, [X Minor Subdivision, Q Site Approval, <br /> QZone Variance, E] Other : <br /> 2. Project location:_,�'cuv-/A �il�e�� o�' 2,6,7, e�S�cf�IYBHlor�� <br /> Describe the project; i .e . , request bei6g made � jr o use . <br /> Identify s ecific roject components : n <br /> �,, o .-Q�r. 7o C? Qin t• o <br /> 3 . Total acreage of project: /13,0e4�# of existing parcels : Z <br /> Assessor Parcel # (s ) : 219F- Z,L - IJ <br /> 4 . If there is an existing EIR assessany 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: 41e0 f; <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />