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Environmental Information Form <br /> Part B <br /> DATE: 7��E�� $ <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 -90A) �o F_ 2 <br /> Address P. o. 13 O X R / <br /> City -S 7-0 C r`-- TON , C i4 <br /> State/Zip 9 S';L0 <br /> Phone Xl h S- 04,r 3l <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, - <br /> [� Zone Reclassification, rg Minor Subdivision, Site Approval, <br /> Q Zone variance, [:] Other: <br /> 2 . Project location: I o,1,1,^.,4-1 99 , /101ANc7' CY4 , C/9 <br /> Describe the project; i.e. , request being made and nature of use. <br /> Identify specific project components : 0wNEi2 S ,- D <br /> G9E.¢re i¢ 3.0 ACiZE /QOMr- S17",- icepA1 A401) 2FXi57"/N6 <br /> 2N . / i4�RE �,f-12/5T/Ni35 �'/2EE GARS+. <br /> 3 . Total acreage of project: c. # of existing parcels: / <br /> Assessor Parcel # (s ) :- �Ob - 03O-10 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: A/ON,E <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 />