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Environmental Information Form <br /> Fart B <br /> DATE: �` 14f, 1,797 <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 <br /> Address %ri' O ✓ r e rte• <br /> City C1'Jr},✓'r-e c/+ <br /> State/Zip A �/� 3 3 6- <br /> Phone ZE5 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Zone variance, KT Other: (Tr 4�x,7 eX C-AtJl'-T Y� - <br /> 2. Project location: /g0�"/ Sou /1LL 'V ley 7-ecA <br /> Describe the project; i .e. , request being madd and nature of use . <br /> Identify specific project components : <br /> ReA., W I�+t �' iS�1,V iC. Y�t�i �-r ► CHH yre ca rd <br /> I:tK4►►-j,V :✓ C 5 I 1 ) ! ��' WC' C !I / CL 's rwwutid 7'V 14Cr;Ay A.1� <br /> c c.�C, / el+- c✓Oc d 'n�L+� .=IC i STi r�+f '�,��N(9 G K G-Iw.�t'�.�. S.�C fi�),Ir 5 Ti <br /> rri i X d %..V i.T-1- Ce► - 99 �ry-�ti Zs dTsc�t d iH- <br /> 3 . Total acreage of prljjre t: / n. 7 r # of existing parcels :_ T/jw'rC- <br /> Assessor Parcel # (s ) : Zq/- 46e - /Fd 19, 2O <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: /110 <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: A10 <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />