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Environmental Information Form <br /> Part B <br /> DATE : zz� <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 FORMROPERTY OWNER AGENT GF OWNER <br /> Name S/4 cG <br /> Address -, <br /> City S' � �G 140 <br /> State/Zip <br /> Phone 7�oy q/-YQ- .Z40"7 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Use Permit, Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Zone variance, Q Other : <br /> 2 . Project location: <br /> Describe the project; i .e . , request bein made n n to e us . <br /> Identify specific pro compone ts : <br /> 3 . Total acreage of project: # of existing parcels : <br /> Assessor Parcel # (s ) : - I 6 -�,,.e - 1-1 <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 /> Use Permit Application - 7 - ( 6/86 ) <br />