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1� <br /> 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— Tcw A , <br /> Address Ig e (')1-1, 5 T— <br /> city -'M-, � <br /> State/Zip (0 --1 !-3-7 (� <br /> Phone p3(— nu -z-2-- <br /> A. <br /> u -LZA. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, EQ Minor Subdivision, Site Approval, <br /> Zone variance, Q Other : <br /> 2 . Project location: (,off 1 S A-41t� c 3i / <br /> Describe the project; i .e . , request being made and nature of use <br /> Identify specific project components : <br /> -5 7D,4 . <br /> 3 . Total acreage of project: 9. 1/9 # of existing parcels : <br /> Assessor Parcel # (s ) <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: do <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 />