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Environmental Information Form <br /> Part B <br /> DATE: 3 S- 7 <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 X PROPERTY OWNER AGENT OF OWNER <br /> Name C Y r C7 c di c' <br /> Address Q`4 <br /> City L ti C /1 Lti10 <br /> State/Zip CA . � :2 3 f <br /> Phone 20 4 •- V,93-- I L 5 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, [3a Minor Subdivision, Q Site Approval, <br /> QZone variance, Q Other: <br /> 2. Project location: 93 1 S PYic.S% RJ �►'����' �"'`'� �" <br /> Describe the project; i .e. , request being made and nature of use. <br /> Identify specif ic-project components : SL, 6d� V1d-r- 60C y.'-/ ACre- <br /> _(�AYce[., fh iv i we V, y5- ACY-e PAIS ee/, 5 FG ,r 1 ry,L4,eo L <br /> A &Id /45r1C - L lurad- USC- <br /> 3 . <br /> SS3 . Total acreage of project: L�• y # of existing parcels : <br /> Assessor Parcel Us ) :: / 93•- 2 ZG• 3'L <br /> 4 . If there is an existing EIR assessin any aspect of your project <br /> site, provide title and date: /77A <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> f]Gr1 <br /> Minor Subdivision - 7 - (6/86 ) <br />