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Environmental Information Form <br /> Part B <br /> DATE : L dw- <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 /> y <br /> PERSON COMPLETING FORM PROPERTY OWNERAGENT OF OWNER <br /> Name �A^I .loA4 u/M Ciowyf7+ P,,041G WoACS <br /> Address 9/0 E H.4*62:72-4 <iy;5 <br /> C i t y Jr-P /✓ <br /> State/Zip CA. 02 <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: ❑ Use Permit, Q Major Subdivision, <br /> Zone Reclassification, FV[ Minor Subdivision, Q Site Approval , <br /> Q Zone variance, [:] Other : <br /> 2 . Project location: e5RSr ACAM/o krAtwl ACRMP°, Gf1 • --- <br /> Describe the project; i .e . , request b ing made and nature of use . <br /> Identify specific project components : PRa?� �NsiSrls '� Tf� <br /> e7o ivy fX 4c?/o�y a` f� ►�JF1L- s/7"� 7`D //►TPAs 1�E 7 � vt�it�i� 5YsT�iv� <br /> 3 . Total acreage of project: 4./9A� # of existing parcels : <br /> Assessor Parcel # (s ) :— o t3- Tom— �4 <br /> 4 . If there is an existing EIR assessing any as ect of your project <br /> site , provide title and date: _ PTvc c1,4P,-+1 104 <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> D t57, <br /> Minor Subdivision - 7 - ( 6/86 ) <br />