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rm <br /> Environmental Information Fo .i <br /> Part B <br /> i <br /> DATE: <br /> (To be Completed By Applicant ) <br /> NOTE : In completing this form, use additional sheets if necessary. I <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 (K)D06— Et3GA fJ�'-S I QC, <br /> Address 4°37 R FF-�!4"It�GYU f1.t t} ►'L bl'L <br /> city <br /> State/Zip S20 <br /> Phone -}tl •O0u - <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit , Q Major Subdivision, <br /> Q Zone Reclassification, X Minor Subdivision, [:J Site Approval, <br /> QZone Variance,- [:] Other : <br /> N W CA 2N t-YL 0 I•-0 to E 712�5F- <br /> 2 . Project location: L='%J&A nn S <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : t <br /> FO(L R?EMat tJCr 060 W1 <br /> 3 . Total acreage of project: 9 # of existing parcels : <br /> Assessor Parcel Us ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />