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Environmental Information Form <br /> .K <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 Raumbach & 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: M Use Permit, Major Subdivision, <br /> Q Zone Reclassification, Minor Subdivision, Q Site Approval, <br /> [] 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 su specific project components : Construct two streets public <br /> well and connect water and storm drain to ad =cent ivision. <br /> 3, _ Total acreage of project: 1 � # of existing parcels : 1 <br /> Assessor Parcel # (e ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> provide title._.and date: None Known <br /> Other_,parmits�and-approval a -4County,. Regional, State and Federal ) <br /> required for this project:. <br /> PERMIT AGENCY <br /> r gii g n .ln?nin Cn. Riii)ding D,Pnt_ <br /> VAJgr & Seatic _ __ San Jnaquin Irncal Healt_nj strict <br /> aQdiyis ion Improvement San Joaquin Cn_ Dept- laf Puhl_i c Wnyk5 <br /> Major Subdivision - 7 - (6/86 ) <br />