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Environmental Information Form <br /> Part E <br /> DATE : seer. �, t98S <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 WOW& E0610EEi_S We . <br /> Address 4-ST9 F—THE?— tVER DR-IUE SUITE A <br /> City STi7CKTDN <br /> State/Zip C.A 9 S-LO-7 <br /> Phone A-7 6-001 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, C& Site Approval, <br /> Q Zone Variance, Q Other: <br /> 2 . Project location: S.E . COR . ` J" STREET RDht) <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : MINI STOPAG-E <br /> 3 . Total acreage of pro ect: <br /> j ±.-7 # of existing parcels : <br /> Assessor Parcel # (s ) : 195 — 1?-1 — 38 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : NONE <br /> 5 . Otherermits and approvals pprovals (County, Regional, State and Federal ) ; <br /> required for this project: <br /> PERMIT AGENCY <br /> 6U1l,DlNGr PERMIT COUNT`( BUtLDItj <br /> " i <br /> i <br /> I <br /> Site Approval Application - 5 - ( 6/86 ) <br />