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Environmental Information Form <br /> Part B <br /> DATE : <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 AGENT OF OWNER <br /> Name Baumbach & Piazza, Inc. <br /> Address 323 West Elm Street <br /> City Lodi <br /> State/Zip CA 95240 <br /> Phone 368-6618 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, XJ Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, ❑ Site Approval, <br /> tJ Zone variance, ❑ Other: <br /> 2. Project location: 5080 E. Eight Mile Road, Lodi, CA <br /> Describe the project; i.e. , request being made and nature of use . <br /> Identify specific project components : Construct two streets, public <br /> well and connect water and storm drain to adjacent subdivision. <br /> 3 . Total acreage of project: 17.2* # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 6� 000-11 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: None Known <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> Grading San .Tna juin Co- Rnilding D=t. <br /> Water & Sentic San Jon4uin T.nca1 Health Di¢trict <br /> Subdivision Improvement San Joaquin Co. DT)=t. of %hlic Works <br /> Major Subdivision - 7 - (6/86 ) <br />