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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 COMPLETING FOP.M PROPERTY OWNER AGENT OF OWNER <br /> Name /Vf0/'�to /1 .S �� k)e� <br /> Address_ ZZ¢ S 4U�ho� v� <br /> City L oC�i <br /> State/zip C! 9524-D <br /> Phone '�3� -Z----'t> <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Ig Minor Subdivision, Q Site Approval , <br /> ElZone Variance, Q Other : <br /> 2 . Project location: S/ <br /> Describe the project; i . e . , ren est bung a ean natu e o use . <br /> Identify specif ' c pr ject compone ts : - 2 <br /> 3 . Total acreage of project: D. 340 T of existing parcels : <br /> Assessor Parcel n (s ) : 195 '7Z- <br /> 4 . If there is an existing ETR assessing any aspect of. your project <br /> site , provide title and date : <br /> S . Other permits and approvals (County , Regional , State and Federal ) <br /> reauired for this project: <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />