Laserfiche WebLink
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 D <br /> City O E=S <br /> State/Zip <br /> Phone(90!) "'521 • A- h <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, ,�nor Subdivision, Q Site Approval , <br /> Zone Variance, Q Other : <br /> 2 . Project location: ?�2��1 �. Ne?��''�-� ��'� F,17�1 iF>,JR� <br /> Describe the project; i .e. , request b ing made and nature of use . <br /> Identify s ecific project components : O O <br /> _ O <br /> ArC• <br /> 3 . Total acreage of project: # of existing arcels : <br /> Assessor Parcel # (s ) : <br /> 4 . If there is an existing EIR ass e s ' ng 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 />