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Environmental Information Form <br /> Part B <br /> DATE: DECEMBER 31, 1987 <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 X AGENT OF OWNER <br /> Name JOHN H. JACOBS AGENT: RICHARD M. BISHOP, L.S. <br /> Address 2823 OCTAVIA STREET 5383 E. FIG AVENUE <br /> City SAN FRANCISCO CA MANTECA <br /> State/Zip CALIFORNIA 94123 CALIFORNIA 9533 <br /> Phone 415)567-0788 209)239-3121 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, F1 Minor Subdivision, Q Site Approval, <br /> Q Zone Variance, Q Other : <br /> 2 . Project location: 28325 E. RIVER ROAD - ESCALON, CA. <br /> Describe the project; i .e . , request being made and nature of use. <br /> Identify specific project components : <br /> CREATE HOMESITE FOR OWNER <br /> 3 . Total acreage of project: 22.9 AC +/# of existing parcels: 1 <br /> Assessor Parcel Us ) :: 247-230-i 1 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: NONE <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : t;/A <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />