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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 X PROPERTY OWNER AGENT OF OWNER <br /> Name Jim Botsford <br /> Address 19909 E. Comstock Road <br /> City Linden <br /> State/Zip CA 95236 <br /> Phone (209) 887-3761 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Minor Subdivision, Q Site Approval, <br /> Zone Variance, Q Other : <br /> 2 . Project location: N/F corner of Kettleman Lane & Clements Road <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : Project includes dividing <br /> 160 acre parcel into an 80 acre and two 40 acre parcels primarily for <br /> agricultural use. One of the 40 acre parcels contains a home. <br /> 3 . Total acreage of project: 160 # of existing parcels : 1 <br /> Assessor Parcel Us ) :: 053-19-03 <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 />