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Environmental Information Form <br /> Part B <br /> to <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 PROPERTY OWNER AGENT OF OWNER <br /> Name K 'eldsen-Sinnock & Associates <br /> Address 1113 W. Fremont St. <br /> City Stockton <br /> State/Zip California <br /> Phone 209 946- <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, D Minor Subdivision, Q Site Approval, <br /> E] Zone Variance, E] Other : <br /> 2344 <br /> 2. Project location: 1 E. River Road <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : To separate existing <br /> residence <br /> 3 . Total acreage of project: 58 . 06 # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 24-7--0-5--TF <br /> 4 . <br /> 7-05- <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: N/A <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> None <br /> _ 7 _ ( 6/86 ) <br /> Minor Subdivision <br />