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Environmental Information Form <br /> Part B <br /> DATE : <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 i5;cJSAti/ 1-4A4 fa0 <br /> Address 940 `t/l� LOO <br /> City <br /> State/Zip GAG/ 47- 115-1-0e7- <br /> Phone <br /> 7- SZos <br /> Phone /. /7S� <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, 5J Minor Subdivision, Q Site Approval, <br /> QZone Variance, Q Other: <br /> 2 . Project location: 19Qoq 4-. <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : G / <br /> 3 . Total acreage of project: 44915;Z* # of existing parcels : / <br /> Assessor Parcel # (s ) : <br /> O8� - O�vO• /5 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: Z0A1E- <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> A/D,C/� <br /> Minor Subdivision - 7 - ( 6/86 ) <br />