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Environmental Information Form <br /> Part B <br /> DATE :- <br /> (To <br /> ATE : (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 /A Z. <br /> Address f: �• ;ii , /; <br /> City <br /> State/Zip <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit , Q Major Subdivision , <br /> Q Zone Reclassification, pa minor Subdivision, Site Approval , <br /> Zone Variance, Q Other : <br /> 2 . Project location: ,24%3G. <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specif is project components : /1✓c , f �, .i� �� �. F,. <br /> .�:Lo r7c d c' �'� r c c �en i 17U- <br /> � CCeLe <br /> 3 . Total acreage of project:_ # of existing parcels : <br /> Assessor Parcel # ( s ) : - .f- 7n.. ' <br /> 4 . If there is an existing EIR assessi74 any aspect of your project <br /> site , provide title and date: A) <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 />