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Environmental Information <br /> For staff Use pnlyy <br /> File No. 154- 9(0- <br /> Date Fi leder _?q -6L <br /> APPLICATION FORM PART H: <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 . It 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 <br /> x AGENT OF OWNER <br /> Name__ Daniel Thom son THOMPSO�L_ENGINEERS . INC . <br /> Address 211T-Wie Drive — ----�___— <br /> City_-_(odes to ^--_---�--- _ -- <br /> State/Zip_CaTitornia,-�3,�3,T;-- -------- _,------ - ---- <br /> Phone_ 209 5Z1 -8986 <br /> --� ---Z----------- ----------_-_-- <br /> TYPE OF APPLICATION_ Major Subdivision - Rezone <br /> PROJECT____._ Wine _County - a 134 lot subdivision <br /> UTHER PERMITS AND APPROVALS (COUNTY, REGIONAL, SPATE AND FEDERAL) <br /> REQUIRED FOR TNIS PROJECT <br /> PERMIT <br /> AGENCY <br /> .--���----1{7'-1- -- --.-_--- <br /> ------------ <br /> —l.. <br /> ..111-'1•� (l.i a:.) ( 9/85) <br /> aRAt'rAA�W - <br />