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Environmental Information Form <br /> Part B <br /> DATE: May 27, 1987 <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 PROPERTY OWNER X AGENT OF OWNER <br /> Name MID-VALLEY ENGINEERING, INC. <br /> Address P.O. Box 816 900 H" Street, Suite G <br /> City Modesto <br /> State/Zip California 95353 <br /> Phone (209) 526-421 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: [:] Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, D Minor Subdivision, Q Site Approval , <br /> Zone Variance, Q Other: <br /> 2. Project location: 31123 S. Koster Road, Tracy, California <br /> Describe the project; i .e. , request being made and nature of use. <br /> Identify specific project components :The proposed Minor Subdivision <br /> will create three new homesites with acreages of not less than 1.5 acres each. <br /> 3 . Total acreage of project: 5 # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 255-110-55 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : Not applicable <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> Not applicable <br /> Minor Subdivision - 7 - (6/86 ) <br />