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Environmental information Fors-19 <br /> DATE : <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 R A.J A Cn A fV Cn A 9 R-A 1 <br /> Address A �c7t� 6 AAN e ke,F <br /> City k AC f State/Zip a <br /> Phone _ g <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Use Permit, 'Major Subdivision, <br /> E] Zone Reclassification, Q Minor Subdivision, [ ] Site Approval , <br /> Zone variance, Q Other : <br /> 2 . Project location: 1 USi S0c7N L"As; or I- A7<hnaP A A110A1 R& A >> <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project cc:nponents : AC ?f S <br /> N' 12 N i KF S i AC i t FA.rn,4�y 2-o %.S <br /> 3 . Total acreage of project: % . 13 # of existing parcels : D N E <br /> Assessor Parcel # (s ) : iq S- l aa 4 R <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 /> Major Subdivision - 7 - (6/86 ) <br />