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Environmental Information F rm <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 acc pted. <br /> PERSON COMPLETING FORM PROPERTY OWNER _AGENT OF OW ER <br /> Name — <br /> Address i23 <br /> City <br /> State/Zip <br /> Phone 2'__13q-4080 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: use Permit, Major Subdivision, <br /> Zone Reclassification, 0 Minor Subdivision, Q Site Approv4l, <br /> Q Zone Variance, 0 Other:Z� ,�,� ,J �,opf'(-T,cr �►�'( ► w1�. <br /> 2. Project location: -(",,jp lvti ►, -T=6U <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : <br /> 3 . Total acreage of project # of existing parcels : <br /> Assessor Parcel # (s ) : 2_tl-Ili— ���oS, OL I`j <br /> 4 . If there is an existing EIR as essing any aspect of your project <br /> site , provide title and date: <br /> 5 . Other permits and approvals (County, Regional, State and Fede al) <br /> required for this project: <br /> PERMIT AGENCY <br /> J <br />