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Environmental Information Form <br /> Part B <br /> /GST <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 l <br /> Address 1'6--, L0 Vd, -irr�e- ,1rc <br /> City / r�r�T`eC4- <br /> State/Zip �'..� /� r;n,� n-'1 /+ °-j 3 3 w <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, [] Minor Subdivision, Q Site Approval , <br /> Q Zone variance, F\71 Other :�p4-4;A,' <br /> 2 . Project location: do( S'% :5r urk /71 `'41^11tx AA re c;'4 <br /> Describe the project; i .e . , request being mad and nature of use . <br /> Identify specific project components : .� j ' lex y ,� 41 ewm <br /> Elueu� lit. %5i SIV N oe--4 <br /> �7Cr:�►+y V :� C !J i l 7��' G" .w c CJI ..i,tw1- TY' lL L 'sJ <br /> e c Y' I c,•� c✓��c�.d <br /> rJ1 i X w i C e-f'dd �.vd S'-/4 AL-r <br /> 3 . Total acreage of pr5ject: /n� -7 z # of existing parcels : 7�r{C- <br /> Assessor Parcel # (s ) : 04/ - leti - /g , ,y -zo <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: Ala <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : Xlo <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />