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Environmental Information Form <br /> Part B <br /> DATE: 4 g NDN• t PS? <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 Kieldsen-Sinnock & Associates, Inc. <br /> Address P. O. Box 844 <br /> City Stockton <br /> State/Zip California 95201-0844' <br /> Phone (209) 946-0268t- <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: ❑ use Permit, [:] .Major Subdivision, <br /> Zone Reclassification, EJ Minor Subdivision, Q Site Approval, <br /> Zone Variance, (� Other: <br /> Portions ot beC. 4, Sec. , Sec. anSec. -Yr <br /> 2. Project location: T. 4 N. , R. 6 E. , M.D.B. & M. <br /> Describe the project; i.e. , request being mae and nature of use . <br /> Identify specific project components : To di <br /> dvide 1003. 44 acres into <br /> two parcels; Parcel 1 being 859. 44 ng <br /> 144 . 00 acres. <br /> 3 . Total acreage of project: 1003. 44 # of existing. parcels : 1 <br /> Assessor Parcel f (s ) : 003-06-01 , 003-06-02 , 003-10-01, 003-10-05 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: No <br /> 5. Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> N/A <br /> N/A <br /> N/A <br /> N/A <br /> 60 <br /> Minor Subdivision - 7 - ( 6/86 ) <br />