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Environmental Information <br /> i <br /> •i;0Q0.. <br /> For Staff Use Only <br /> File No .-- <br /> D <br /> o ._ __—_— <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 <br /> X AGENT OF OWNER <br /> Name__ _Albert M. Honthass ------ ----- -- -- --------------- - <br /> Address P.o._Box 218 ---- <br /> C i t y_ _F4rmjngton —_--- _ - — ---- _--- <br /> State/Zip_ California 95230 <br /> Phone_-1209)886-5454 — <br /> TYPE OF APPLICATION Minor subdivision —__ ----- <br /> PROJECT to separate-homesiteT- <br /> OTHER PERMITS AND APPROVALS (COUNTY, REGIONAL, STATE AND FEDERAL ) <br /> REQUIRED FOR THIS PROJECT <br /> AGENCY <br /> k�ERMI'T <br /> -1- (9/85 ) <br /> 1'1:111-44 (12/85) <br />