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Environmental Information Form <br /> Part B <br /> DATE : -.z2e,. Zd 1,qg8 <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 �Qu�,.6Gu� /L ZZa <br /> Address ,3 Z.3 u�. C/•y, .T� <br /> City Loan•' <br /> State/Zip er /Ave �1S24o <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, n Minor Subdivision, Q Site Approval, <br /> Zone variance, Q Other : <br /> 2 . P r o j e c t l o c a t i o n: z�7 ��o•,,�o - %Z �llG t�= .� ,t5ruc/�t �/ <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : ,/--Z/ ,P-.?" a,""" <br /> 3 . Total acreage of project: So # of existing parcels : Z <br /> Assessor Parcel # (s ) 217 - A90 - /3 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site.,, provide title and date: <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : <br /> PERMIT }} AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />