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Environmental Information Form <br /> Part B <br /> DATE : /�Od. /o. <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 z'7._ <br /> Address 3 <br /> City <br /> State/Zip l'i/, Z.SZ -Xv <br /> Phone 3Gg —GLIB <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, Q Major Subdivision, <br /> Q zone Reclassification, ,J!�Minor Subdivision, D Site Approval , <br /> Q Zone variance, Q Other : <br /> i <br /> 2 . Project location: f.fl,:6 E//vfY S. <br /> Describe the project; i .e. , request being maefe and nature of use . <br /> Identify specific project components : zo3-� 4, /20 .b?, <br /> 3 A-1, .- — /20 ^Z- i:r — t 4c- <br /> ::!r <br /> s Tle <br /> 3 . Total acreage of project: 'Z-43 Ai, # of existing parcels : o.y<- <br /> Assessor Parcel # (s ) : Di 7- Z ? - i9 <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 /> i <br /> Minor Subdivision - 7 - ( 6/86 ) <br />