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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 /> Name 37. e <br /> Address15 <br /> p <br /> City_ /.L-)nnr-l_1aletdc,r <br /> State/ZipZSk <br /> Phone X 09- .3?S - V,;9 4 - _. <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Use Permit, Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, [] Site Approval , <br /> Zone variance, Q Other : <br /> 1 . Project location: &.+Ld �;a�i tea.., g$ �,,� Sack+ems Pl(. A4A 6f <br /> k�Describe• the project; i .e . , r ques being made and natre of <br /> use . Lam <br /> Identify specific project -:poner.ts : C <br /> 52 -2 �escc�t•+`fio.� � Rcep �0�4� 1SCR�S <br /> +e+.J I s Prr.%0 <br /> 3 . Total acreage of project: X53 # of existing parcels : <br /> Assessor Parcel # (s ) : OS -1 bo- o), or065 i !P, <br /> 4 . If there is an existing Ej.,k assessing any aspect of your project <br /> site , prc,vide title and date : /)DNS <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> Major :-,Ybd1.vision - 7 - (6/$6 ) <br />