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Environmental Information Form <br /> Part B <br /> DATE : �� 2 S— eq <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 /> NameZ z4. <br /> Address 323 w. Cis sf <br /> City Lodi <br /> State/Zip <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Major Subdivision, <br /> Zone Reclassification, �<Minor Subdivision, Q Site Approval, <br /> Zone Variance, Q Other: <br /> 2 . Project location:_ SE/.oc ,Cac7'e'y'p 34 — 7- <br /> ..4".rJ,e74 <br /> Describe the project, i .e. request being made and nature of use . <br /> Identify specific project components : ,��a;e6- <br /> !n o 2 — -'o ACi'G oggL G -r <br /> 3 . Total acreage of project: ?D # of existing parcels : / <br /> Assessor Parcel # (s ) : 007 - /00 - 07 <br /> 4 . If there is an existing EIR assessing 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 />