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Environmental Information Form <br /> Part B <br /> DATE : December 27, 1988 <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 X PROPERTY OWNER AGENT OF OWNER <br /> Name Vernon R. Green <br /> Address 1629 Barcelona Ave. <br /> City Stockton <br /> State/Zip CA 95209 <br /> Phone 951-5830/951-7695 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, E] Major Subdivi:ion, <br /> Q Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Q Zone Variance, Q Other : <br /> 2. Project location: 2645 Pock Lane <br /> Describe the project; i .e. , request being made and nature of use. <br /> Identify specific project components : <br /> 3 . Total acreage of project: 1.78 # of existing parcels: 1 <br /> Assessor Parcel Us ) :: 171-250-14 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: NONE <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project : <br /> PERMIT AGENCY <br /> None <br /> Major Subdivision - 7 - (6/86 ) <br />