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Environmental Information Form <br /> Part B <br /> DATE: 7 <br /> .—r <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 /> P1'eaAp, 4q!g9t1(A&^vf! blanks . Incomplete forms cannot be accepted. <br /> PERSON COMPLETING FORM PROPERTY OWNER _AGENT OF OWNER <br /> Name — <br /> Address lZ ' <br /> City M'A&n-r_4A_._ C,,: <br /> State/Zip 3 G <br /> Phone <br /> A. - PROJEW. PZ,SC�RZP, IO"N <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> D.tZpne kP,,eFltqsi,-f-�qationf QC Minor Subdivision; Q Site Approval, <br /> Zone variance, Q Other: J <br /> 2 . Project location: \64E;e_, AE <br /> Describe the project; i.e. , request being made and nature of use . <br /> Identify specific project components : *P^e cC _ FDQ- <br /> • �� •.•d-. Q •F� �LfT F1C'.4ti 2D A�. +"�ctQtFt,. <br /> 3 . Total acreage of project: # of existing parcels : <br /> Assessor Parcel # (s ) : <br /> l•.•• 1f�1 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: <br /> 5 . Other pe i-ts .and approvals -(County, ai.ional, State and Federal ) <br /> required or this project: <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />