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Environmental Information Form <br /> Part B <br /> DATE: T)ECEMRER 1 5, 1986 <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 Xj�__PROPERTY OWNER AGENT OF OWNER <br /> Name JOHNNIE & LEOLA ROUNTRF.F. <br /> Address 31124 SOUTH HWY 33 <br /> City TRACY <br /> State/Zip CA 95376 <br /> Phone (209) 836-1706 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> [� Zone Reclassification, [D Minor Subdivision, Q Site Approval , <br /> Q Zone variance, Q Other : <br /> 2 . Project location: EAST SIDE OF HWY 33, APPROX. 1,600 FT. NORTHWEST OF DURHAM FERRY <br /> Describe the project; i .e. , request being made and nature of use . ROAD. <br /> Identify specific project components : REQUESTING TO SUBDIVIDE AN EXISTING <br /> 5 ACRE PARCEL INTO THREE 65,000 S.F. LOTS. TWO OF THE LOTS WILL BE SERVED BY A 50' <br /> WIDE PRIVATE ROAD IMPROVED TO SAN JOAQUIN COUNTY STANDARDS. <br /> 3 . Total acreage of project: 5.00 # of existing parcels : ONE <br /> Assessor Parcel # (s ) :- 255-110-57 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: N/A <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> P .R "OLATTON TEST T.QrAT. RRAT.TV nPPT <br /> RIJTT.DTNG PF.RMTT RITTT.DTur_ nEPT <br /> WELL PERMIT TDCAT. NRAT.TR nRPT, <br /> Minor Subdivision - 7 - ( 6/86 ) <br />