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Environmental Information Form <br /> Part B <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 '6e" S-0 /- e�o <br /> Address 3 74 7 Al, k'PnnP C� <br /> City f{GQ SHO, <br /> State/Zip C,¢ CrS"Z2c) <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Major Subdivision, <br /> E] Zone Reclassification, Q Minor Subdivision, Site Approval, <br /> Zone variance, Q Other: <br /> 2 . Project location: Z , S70 A.1, /live <br /> Describe the project; i .e . , request being made and natur6 of use . <br /> Identify secific project components : <br /> -70/7,-7 F tfe►-e Z-M c far- /e Azirs <br /> 3 . Total acreage of project: # of existing parcels : 3 <br /> Assessor Parcel <br /> 4 . If there is an existing EIR assessin any aspect of your project <br /> site , provide title and date: All/ <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> SO <br /> Site Approval Application - 5 - ( 6/86 ) <br />