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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 X AGENT OF OWNER <br /> Name Baumhach & Piazza <br /> Address 323 West Elm Street <br /> City Incli <br /> State/Zip CA 9S240 <br /> Phone 369-6618 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, [D Major Subdivision, <br /> Q Zone Reclassification, a Minor Subdivision, E] Site Approval , <br /> Zone variance, Q Other : or Lot Line Adjustment <br /> 2 . Project location: South side of Tokav Colony Road 1/2 mile West of .Jack Tone <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : There has been two dwellings on <br /> this property for mangy years This application is to change the rental tuiit <br /> to owner occupied dwelling. <br /> 3 . Total acreage of project: 4.1 + # of existing parcels : 2 <br /> Assessor Parcel # (s ) : 063-280-18 and 17 <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 /> NONE <br /> Minor Subdivision - 7 - ( 6/86 ) <br />