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Environmental Information Form <br /> Part B <br /> DATE :— <br /> (To <br /> ATE : (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 PROPERTY OWNER X AGENT OF OWNER <br /> Name <br /> Address <br /> City ]icy <br /> State/Zip rq. SS3 <br /> Phone f3S-i�/3 <br /> A. PROJECT DESCRIPTION <br /> I_ Type of application : Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, Q Site Approval , <br /> Zone variance, Q Other : <br /> 2 . Project location: e - �sa4'ZXI m,= °sem ��Hf,,,,., <br /> Describe the project; i . e . , request being made and nature of use . <br /> Z ntify specific project components : <br /> ,e E e c <br /> v ioE� / 4t ✓ LS�/k F <br /> 3 . Total acreage of project: 9l � /E # of existing parcels : Z <br /> Assessor Parcel # (s ) :SSS-- ?70 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : Wo <br /> S . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT A-GENNCCY- <br /> 40 oV/N <br /> General Plan Map Amendment <br />