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Environmental Information Form <br /> Part B <br /> DATE Febru Yt 1 198f3 - <br /> (To be Completed By Applicant ) <br /> NOTE : In completing this form, use additional <br /> yoursabilit . necessary . <br /> question <br /> Answer all questions to the best of y Y • <br /> is not applicable to your project, write NA (not applicable ) . <br /> Please <br /> forms cannot be accepted. <br /> lease do not leave blanks . Inco <br /> PERSON COMPLETING FORM <br /> PROPERTY OWNER X AGENT OF OWNER <br /> Name Chas. H. Bloom Co. nc <br /> Address P. 0. Box 267 <br /> City Stockton CA 95201 <br /> State/Zip CA 95201 <br /> Phone 209 948- <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application : Q Use Permit , [:] Major subdivision , <br /> � Minor <br /> Subdivision, El Site Approva'� , <br /> Zone Reclassification, <br /> Zone Variance , ❑ Other : <br /> 2. Project location: Next to 1990 N. Picolli Road <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : to incorporate 9.46 acres <br /> adjacent to APN 101-210-01 as M-1 <br /> 3 . Total acreage of project : 49.46 # of existing parcels : i <br /> Assessor Parcel x (s ) : 101-210-04 <br /> EIR assessing any aspect of your project <br /> 4 . Z`_ there is an existing ' <br /> site , provide title and date: <br /> (County , Regional , State and Federal ) <br /> 5 . Other permits and approvals <br /> required for this project: <br /> AGENCY <br /> PERMIT <br /> No req <br /> - � - ( 6/86 ) <br /> Zone Reclassification <br />