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Environmental Information Form <br /> PCJ1n B <br /> DATE : <br /> (To be Completed By Applicant ) <br /> NOTE : In completing this form, use additional sheets if necessar <br /> Answer all questions to the best of your ability. If a qu stion <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 t� PROPERTY OWNER AGENT OF OWNER <br /> Name <br /> Address - V16 `v,CZ <br /> City <br /> State/Zip GL C <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application : Use Permit , Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval , <br /> Zone Variance, ❑ Other : <br /> 2. Project location: 7,ZE - PCZ, 'S+- . W 1DO Sr1 4Q, A, �aS� <br /> Describe the project; i .e . , re uest being made a d nattire of se . <br /> Identify specific project components : Ccv1,J <br /> 3 . Total acreage of project: , of existing parcels : f <br /> Assessor Parcel 1'r (s <br /> 4 . If there is an existing EIR assessing any aspect of your prof ct <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 /> Use Permit Application - 7 - ( 6/86 ) <br />