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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 XX PROPERTY OWNER AGENT OF OWNER <br /> Name Harry J. & Margaret C. Franse <br /> Address 21877 N. Ray Road <br /> City Lodi. <br /> State/Zip CA 95240 <br /> Phone 209-369-8928 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> QZone Variance, Q Other: <br /> 2 . Project location:_ 21877 N. Ray Road <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specif is project components : Create residential hom si tp from <br /> 22.3 acre agricultural parcel. <br /> 3 . Total acreage of project: 22.3 # of existing parcels : <br /> Assessor Parcel # (s ) : 011-17-8 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: N/A <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> N/A <br /> Minor Subdivision - 7 - ( 6/86 ) <br />