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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 X PROPERTY OWNER AGENT OF OWNER <br /> Name Z)04�4e/ZS Z. <br /> Address fro, t3ox /t[ <br /> City <br /> State/Zip <br /> Phone !Z&3,79 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, Q Site Approval , <br /> Zone variance, Other : <br /> 2 . Project location: /73sz .<l <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project cpmponents : <br /> ft�.,ry l/E <br /> 3 . Total acreage of project: # of existing parcels : <br /> Assessor Parcel # (s ) GJ'/ - /p0- c6 <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 /> Use Permit Application - 7 - ( 6/86 ) <br />