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Environmental Information Form <br /> Part B <br /> DATE : <br /> , <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 OWNERy AGENT OF OWNER <br /> Name ,�:�/ /r"��2/EG s ,QS<SoG. - r�Cr'iYE� T'r-�•rrGEe T <br /> Address 4045 GO �'wv,�po ,4y�iy�lE <br /> City S'7-oa e7lo <br /> State/Zip CA o¢ <br /> Phone 943 -zoL/ <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Zone variance, Q Other: <br /> 2 . Project location: 077 S. /yam ,L>O.QC) <br /> Describe the project; i .e . , request being made and nature of use . <br /> I7ntify specific project components : <br /> . U <br /> 3 . Total acreage of project: 94A6 # of existing parcels : <br /> Assessor Parcel Us ) : <br /> : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : /✓D <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> �Ll//�/GL 5��3.���/Sia-✓ ' " �� ,� •i <br /> General Plan Map Amendment 11 ( 6-86 ) <br />