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Environmental Information Form <br /> Part B <br /> DATE : DECEMBER 19. 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 XX PROPERTY OWNER AGENT OF OWNER <br /> Name JORGENSEN WALKER, INC <br /> Address 22496 S TINNTN ROAD <br /> City MANTECA <br /> State/Zip CA 95336 <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, H Minor Subdivision, Q Site Approval , <br /> Zone variance, Q Other : <br /> 2 . Project location: A PORTION OF SEC 23, T 2 S R 6 E M n R k M <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : <br /> 3 . Total acreage of project: 80. 11 # of existing parcels : nug <br /> Assessor Parcel # (s ) : 241-220-1 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: NIA <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> PERCOTATrON TEST LOCAL HFALTH DEPT- <br /> WELL <br /> EPT WELL PERMIT LOCAL HFATTH DEPT <br /> BUILDING PERMIT BUILDING DEPT <br /> Minor Subdivision - 7 - ( 6/86 ) <br />