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Environmental Information Form <br /> ' r <br /> Part B <br /> DATE : -5 - 2 89 <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 questiin <br /> is not applicable to your project, write NA (not applicable ) . <br /> Please do not leave blanks . Incomplete forms ca. not be accepted. <br /> PERSON COMPLETING FORM x PROPERTY OWNER AGENT OF OWNER <br /> Name /i/IDi1/TE / • 5C1f9Z- � (,-ZEN CULF3ERTS V <br /> Address ZZ 4 S AV6�--'AIA .4 VE <br /> City L o D/ <br /> State/Zip C4 9 5 2 4 0 <br /> Phone 3 34 - eos z -:-� - <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Zone Reclassification, X Minor Subdivision, Q Site Approval., <br /> QZone Variance, ZZ20*I' / <br /> /'/' <br /> 2 . Project location: �O�yeeln <br /> �l�/O i Purl I I et- <br /> Describe the project; i.e . , request bei g made and nature dt use . <br /> Identify specific project components :Aoar" <br /> '�-c CrCr� <br /> 3 . Total acreage of project: 9. 5 # of existing parcels : <br /> Assessor Parcel # (s ) : O o 7 — -- <br /> 4 . If there is an existing EIR assessing any aspect of you- 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 /> Minor Subdivision - .7 - (6/86) <br />