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For Staff Use Only <br /> File No . <br /> Date Filed <br /> APPLICATION FORD, 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 X PROPERTY OWNER AGENT OF OWNER <br /> Name Albert Bogetti <br /> Address P.O. Box 705 <br /> City Vernalis <br /> State/Zip CA. , 95385 <br /> Phone (209)523-2642 <br /> TYPE OF APPLICATION Minor Subdivision <br /> PROJECT to create homesite_parcel for son. <br /> OTHER PERMITS AND APPROVALS (COUNTY, REGIONAL, STATE AND FEDERAL) <br /> REQUIRED FOR THIS PROJECT <br /> PERMIT AGENCY <br /> N/A N/A <br />