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Environmental Info y-mation Form <br /> Part B <br /> DATE: May 15. 1999 <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 ROBERT & NANCY MERRIHEW <br /> Address Nnnru ni TVF AVF — <br /> City STnr'TnN <br /> State/Zip ra 95?n5 <br /> Phone (?n9) g4R R1RA wnrk ph A 94:2 =94- <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: FX] use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, E] Site Approval, <br /> QZone Variance, [:] Other : <br /> 2. Project location: 12112 Norm^n AvP <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : 1;�FnMil;, RuildinQ <br /> 3 . Total acreage of project: 5 # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 103-210-66 <br /> 4 . If there is an existing EIR assessing any aspect of yot•r project <br /> site, provide title and date: n/., <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> Building S J Count, <br /> _ Encroachment S I rn uty <br /> Sept i r <br /> Private Rights-of-Way -7- ;8/86 ) <br />