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1 - <br /> Environmental Information Form <br /> Part B <br /> DATE : NCV,, `5 )C')E�b <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 <br /> Address 1 4 3U IX r ^4•►V Rb 'F�-V Q. i <br /> City , <br /> State/Zip C-t�j �, -;,- ' e) '�... <br /> Phone -�)1, d 5.41— 1 1.,DZ) - <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Major Subdivision, <br /> E] Zone Reclassification, Q Minor Subdivision, E] Site Approval, <br /> Zone variance, �fl Other : <br /> 2 . Project location: N , ,tp1^ tAwif� --tL'L <br /> Describe the project; i .e. , request bei►ng made and nature of use.' <br /> Identify specific project components : in)D�3 !T'Dl_ <br /> 3 . Total acreage of project: # of existing parcels : 1 <br /> Assessor Parcel # (s ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: T-13'D- <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> Site Approval Application - 5 - ( 6/86 ) <br />