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Environmental Information Form <br /> Part B <br /> DATE : 7 -,eg <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 X AGENT OF OWNER <br /> Name J`�e,FI//sn �u'-n lcs� �/y � .S'ie�i i� i�� <br /> Address ¢G¢5 Go"W '411/e, <br /> City 5,740 /V'? Ci9 <br /> State/Zip G1.9 <br /> Phone 9¢3-zoz-/ <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Zone variance, 5Q Other: IPI�re ��ldsr�yl�LT <br /> 2 . Project location: a,, � 0'74 e74 <br /> Describe the project; i :e . , request being ad and nature of use . <br /> Identify specific project components : <br /> /ll Css /4 Cassa 7/.LIV o9 i'me <br /> 3 . Total acreage of project: //ji # of existing parcels : <br /> Assessor Parcel # (s ) :- <br /> 4 . <br /> (s )4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: /J/� <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> General Plan Map Amendment 11 ( 6-86 ) <br />