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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 CCMPLETINNG FORM ! PROPERTY OWNER _AGENT OF OWNER <br /> Name ,Z7�lN.r,� a vsf e- /i 0 z z.t <br /> Address —� <br /> City Low, <br /> State/Zip e'w fsZ}40 <br /> Phone 3G B -agile <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> �] Zone Reclassification, D? Minor Subdivision, 0 Site Approval , <br /> Q Zone variance, Q Other : <br /> 2 . Project location; A6V v�,r ,tel <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : <br /> 3 . Total acreage of project: 77 t # of existing parcels : aocc <br /> Assecsor Parcel # (s ) :- Q2s'- /G —/-7 <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 /> Acne- <br /> Minor <br /> � cne <br /> Minor Subdivision - 7 - ( 6/86 ) <br />