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: Environmental Information Form <br /> Part B <br /> DATE : <br /> TT (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 <br /> City <br /> State/Zip <br /> Phone 17, <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, ❑ Other : <br /> 2 . Project location: 115-9 X L/N� 12-vAlt'D . <br /> Describe the project; i .e . , request being made and na ure of use . <br /> Identify specific roject components : F. t <br /> l(-I T=( <br /> 3 . Total acreage of project: r 9S # of existing parcels : <br /> Assessor Parcel # (s ) : ! � �� Z <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 /> PJv 1 u710 r,, PEI-t-A I TStMa U <br /> Use Permit Application - 7 - ( 6/86 ) <br />