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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 X AGENT OF OWNER <br /> Name Jim Boone <br /> Address P. 0. Box 128 <br /> City Farmington <br /> State/Zip California 95230 <br /> Phone ( 209 ) 886- 5337 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, 7-7 Site Approval , <br /> Zone variance, Q Other : <br /> On Farmington Road (Highway 4 ) approximately <br /> 2 . Project location: 1 mile west of Escalon Bellota Rd. <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : Development of a par 3 , <br /> 9 hole golf course for public use includclub house <br /> and restroom facility. <br /> 3 . Total acreage of project: (±)18.6)k # of existing parcels : 2 <br /> Assessor Parcel # (s ) : 187-040-15 and 187-050-10 <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 /> Restroom Septic System Public Health Department <br /> Site Approval Application - 5 - ( 6/86 ) <br />