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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 �� ....� <br /> Address s �r.J/� ✓i r JAS <br /> City rf <br /> State/Zip 57'f 33 <br /> Phone 2'77 <br /> i A. PROJECT DESCRIPTION <br /> 1. Type of application: use Permit, Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Site Approval , <br /> Zone variance, [:J Other : <br /> 2 . Project location: <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : �..�crE�icrrY,f.� <br /> y �v�� �Fr��•� ��nr i' �riZt UTiI� -J ,4 �� �9G�F �•�7�CrL <br /> 3 . Total acreage of project: ;2.�7" /;G. # of existing parcels : <br /> Assessor Parcel Us ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: W"!A <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project : <br /> PERMIT AGENCY <br /> Site.,Approval Application - 5 - ( 6/86 ) <br />