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,• 'OP�U,N C Environmental Information <br /> is• .y <br /> qC/PORN <br /> For Staff Use Only <br /> File No . <br /> Date Filed <br /> APPLICATION FORM PART B: <br /> ENVIRONMENTAL INFORMATION <br /> (To be Filled Out 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 X AGENT OF OWNER <br /> Name Kjeldsen-Sinnock & Associates, Inc. <br /> Address ox 844 <br /> City Stockton, <br /> State/Zip Ca.Mtornia9b201-0844 <br /> Phone946-0268 <br /> TYPE OF APPLICATION Minor Subdivision & Lot line adjustment <br /> PROTECT _ To adjust the property line between Lots 21 & _22 and to <br /> divide Lot 21 into a 0 . 5 -acre parcel & a 0.4 parcel _ <br /> OTHER PERMITS AND APPROVALS (COUNTY, REGIONAL, STATE AND FEDERAL) <br /> REQUIRED FOR THIS PROJECT <br /> PERMIT AGENCY <br /> Q�)NE <br /> -1- (9/85 ) <br /> Plan-44 (12/85) <br />