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x4'��Ati Environmental Information <br />For Staff Use Only <br />File No. ZR- 87- !0 <br />Date Filed <br />APPLICATION FORM PART B: <br />ENVIRONMENTAL INFORMATION <br />(To be Filled Out By Applicant) <br />NOTE: In completing this form, use additional sheets if necessary. <br />Answer all questions to the best of your ability. If 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 />Daniel Thompson <br />Name Thompson -Hyl ll Engineers <br />Address 1016 12th Street <br />City Modesto <br />State/Zip California 95354 <br />Phone (209) 521-8986 <br />TYPE OF APPLICATION See reclassification <br />PROJECT Single family residential subdivision <br />OTHER PERMITS AND APPROVALS (COUNTY, REGIONAL, STATE AND FEDERAL) <br />REQUIRED FOR THIS PROJECT <br />PERMIT <br />-1- <br />Plan -44 (12/85) <br />AGRNCY <br />(9/85) <br />