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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 I PROPERTY OWNER L-K ENT OF OWNER <br /> Name C s -e 4 u r I e d .l C o. <br /> Address / 0 c k'v F <br /> City , <br /> State/Zip <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, EJ-91—nor Subdivision, ❑ Site Approval , <br /> QZone variance , Q Other : <br /> 2 . Project location: 17G,e: . - c�-' t,2,z <br /> Describe the project; i .e. , request ing made and natu a of se . <br /> Identify specific project components : A- <br /> 3 . Total acreage of project: - # 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 : r--- <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 />