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f <br /> `Pm onmen�al Information Form <br /> Part B <br /> Dr / /z2 / 7S- <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 . I` P <br /> L a question <br /> is not applicable to your project, write NA ( not applicable ) . <br /> Please do not leave blanks . Incomplete forms cannot be accented. <br /> PERSON COMPLETING FORM _ PROPERTY OWNER -AGENT OF OWNER <br /> ILC <br /> Name v y v G 14 <br /> Address '7 <br /> City <br /> State/ZiD 5' Z <br /> Phone <br /> A . PROJECT DESCRIPTION <br /> Type of application : Q Use Permit, Major Subdivision, <br /> 1� Zone Reclassification, Q Minor Subdivision,, � Site Approval , <br /> Zone variance , 71 Other : <br /> 2 . Project location : <br /> Describe the projec i . e . , request being mace ana natu_� o�'Ident_` u <br /> Project <br /> components : <br /> Total acreaae of project:_ - o= exis- ing parcels : <br /> :.ssessor Parcel- - ( s <br /> If there is an e::istinc EIR assessing any aspect of your project <br /> site provide __tle ana date : <br /> 5 . Other permits and approvals (Couty , Regional , State and Fe6eral ) <br /> rec-luired =or this project . <br /> J^'7MIT <br /> AGENCY <br /> Zone Reclassi- ica- 4 _ <br /> 7 - ( 6/86 ) <br />