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Environmental Information Form <br /> Part 6 <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 CCMPLETING FORM ✓ PROPERTY OWNER AGENT OF OWNER <br /> Name 0 e.`2iAV 'Of--- 4 <br /> Address o�-v 7Li� r .� ✓sy A t6 <br /> City Pe- S7b L1,C- <br /> State/Zip <br /> ,C- <br /> State/ZipL-,4- Gi /_' C/-'/J'� 6 <br /> Phone Zzi,S-- - <P )--9' -.2L-7GG oiz cf - Sf z — 7 -i-C- <br /> A. <br /> C-A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, ❑ Major Subdivision, <br /> Zone Reclassification, [D-Minor Subdivision, Q Site Approval , <br /> Q Zone variance, Q Other: <br /> 2 . Project location: 3 9�9 �� e,C� iS �uAN d , �/��Cc <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : <br /> C>t/✓/✓G-- % O <br /> 3 . Total acreage of project: 3 lf"«#hof existing parcels : 6 l• 7 <br /> Assecsor Parcel Us ) :: S 3 - /9 o - i f <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 />