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Environmental Information Form <br /> Part B <br /> DATE :- <br /> (To <br /> ATE : (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 AGENT OF OWNER <br /> I <br /> Name 1X011111 0191V (J/r"Z-;'V <br /> Address - <br /> C i t y O,O.X <br /> State/Zip C' ' <br /> Phone 4 r - <br /> -� <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, +"Minor Subdivision, Q Site Approval , <br /> Q Zone variance, Q Other: <br /> 2 . Project location:_ <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : / Gf�ieCi=C FUS <br /> ? . Total acreage of projectrl,5-Aqe . I of existing parcels: <br /> Assessor Parcel Us ) : f-/ -/ <br /> 4 . If there is an existing EIR assess;rA any aspect of your project <br /> site, provide title and date: ,n/�/9 <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 />