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Environmental Information Form <br /> Part B <br /> DATE : SAN 2S1 1989 <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 AGENT OF OWNER <br /> Name N D L-i•E A.H D A sso C-%A,-r E S <br /> Address I Z 3 N S`(C A M o P-E ' AY E <br /> City MArdTE cfa <br /> State/Zip GA 9 S 33 Co <br /> Phone ( Zo!) 2 39 -9 O 8 0 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, [:] Major Subdivision, <br /> Zone Reclassification, Minor Subdivision, Site Approval, <br /> Zone Variance, Q Other : <br /> 2 . Project location: 2190 5 . SAc.k —10 ,A 1E T,0A� j 1 P0r4 <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : \NluL- <br /> IE SPLIT FROM A L_M o►s n oFzc}{Afz>7 Folz Pv(zPoSE S o F <br /> $ETiy-enaNT No [NAN6E PRDPosCtO Fat EARM1NCo <br /> oQE?,A'Tlant <br /> 3 . Total acreage of project: # of existing parcels : <br /> Assessor Parcel # (s ) :- <br /> --z-0(s ) : Zo <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: NONE- <br /> 5 . <br /> ON5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> n( c� rVC <br /> Mi.nor. Subdivision - 7 - ( 6/86 ) <br />