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Environmental Information Form <br /> Part B <br /> DATE • J 3/ <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 <br /> Address "I C, <br /> City <br /> State/Zip <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application : Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Site Approval , <br /> Ft-- <br /> / r <br /> Zone Variance, E] Other : R �' r I^ r JK � <br /> Ca 9 S; v IN- <br /> 2 . Project location: <br /> Describe the project; i .e. , request bein made,-and nat re of us , <br /> I"ntify spec is �roject �o:pponents : f <br /> /J ,� / Y G' <br /> 3 . Total acreage of project: 10 (��� of existin parcels : Gam_ <br /> Assessor Parcel Us ) : <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 /> Use Permit Application - 7 - ( 6/86 ) <br />