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Environmental Information Form <br /> Part B <br /> DATE : J___ a=uary 98 <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 acceptec2 . <br /> PERSON COMPLETING FORM X PROPERTY OWNER AGENT OF OWNZR <br /> Name Berman P. Keesee and Jessie Mae Keesee <br /> Address 1301 Joan Avenue <br /> City Stockton <br /> State/Z1pCn1if.ornia 95207 <br /> Phone 07-2286 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: ['j Use Permit, <br /> Major Subdivision, <br /> ' ( Zone Reclassification, [-] Minor Subdivision, E] Site Approval , <br /> i <br /> 1 Zone Variance , LJ Other : <br /> South side of Hammer Lane approximately 273 feet East <br /> 2 . Project location: of Parshin Avenue. <br /> Describe the project; i . e. , request being made and nature of use . <br /> ct components : Profexsional Offices (Dentist, <br /> Identify specific proje <br /> Orthodonist etc. <br /> 3 . Total acreage of project: 1.0 acre of existing parcels : 2 <br /> iAssessor Parcel s (s ) : 077-404 and 077-405 <br /> 1 <br /> 4 . If there . is an existing EIR assessing any aspect of your project <br /> site , provide title and date: N/A <br /> 5. Other permits and approvals (County , Regional, State and Federal ) <br /> required for this project : <br /> PERMIT AG:.NY <br /> N/A <br /> I • <br /> J ' <br /> 1 <br /> Zone Reclassification - 7 ( 6/86 ) <br /> - <br />