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Environmental Information Form <br /> Part B <br /> DATE: AUG . ' ', ( EJ�7 <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 H <br /> Address 325 W. W(L-(,OUJ S"f <br /> City �OGK-TO <br /> State/Zip C.+6 - tJ 203 <br /> Phone wo LyoIGE <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Ozone Reclassification, Q Minor Subdivision, 5�' Site Approval , <br /> QZone Variance, Q Other : <br /> 2 . Project location: FWZL,#'2 NQL)151RIOL N � <br /> Describe the project; i .e . , request being made and nature f use . <br /> Identify specific project components : OJE L 30 SPAS <br /> NE <br /> 3 Total acreage of project: -lb(z) # of existing parcels: <br /> Assessor Parcel Us ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: I4 A <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> Site Approval Application <br /> - 5 - (6/86 ) <br />