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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 FORM _PROPERTY OWNER AGENT OF OWNER <br /> Name .CA 4)/P-EA)L <br /> Address_ i/ J 9A �'rEA1T Rte <br /> City <br /> State/Zi <br /> 1P 07, <br /> Phone X33 5� /.3/Co <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, � Minor Subdivision, Q Site Approval, <br /> QZone Variance, Q Other : <br /> I ,I / <br /> 2 . Project location: (141 T c t <br /> Describe the project; i .e. , request being made and nature of u'se. d <br /> Identify specific project components : ZZ 72: /9d <br /> ,�nm /177 <br /> 3 . Total acreage of project: //77 # of existing parcels : / <br /> Assessor Parcel Us ) :: z. -)6- 07, <br /> 2S- /3 -D <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: AM <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 />