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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 PROPERTY OWNER AGENT OF OWNER <br /> i <br /> Name <br /> Addresses ":�,� ' <br /> city A P-T-o <br /> State/Zip <br /> Phone—(,i,, <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, D Minor Subdivision, N Site Approval, <br /> QZone variance, Q Other : <br /> 2 . Project location: <br /> Describe the project; i .e. , request being made and nature of use. <br /> Identify specific project components : <br /> 3 . Total acreage of project: � . :3�') # of existing parcels: <br /> Assessor Parcel # (s ) : <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 /> Site Approval Application - 5 - ( 6/86 ) <br />