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Environmental Information Form <br /> Part B <br /> DATE• 6 8/ <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 /1011 C <br /> Address 'Z'LAV-660 -A Lo <br /> City p <br /> State/Zip <br /> Phone •• <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application : Q Use Permit, E] Major Subdivision, <br /> Zone Reclassification, [0 Minor Subdivision, Q Site Approval , <br /> Zone Variance, Q Other :�G�^��`���urQ fpjjLos/ <br /> 2 . Project location: <br /> Describe the project; i .e . , request being ade and nature of use . <br /> Identify specific project co onents : i , <br /> Q <br /> - r <br /> 3 . Total acreage of project:--4-1!51 # of existing parcels :—/ <br /> Assessor Parcel # (s ) : 25.51" ZOO — O 3 <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 /> Minor Subdivision - 7 - ( 6/86 ) <br />