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Environmental Information on Form <br /> Part B <br /> DATE : <br /> .j (To be Completed By Applicant ) <br /> J 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 /> � I <br /> .! PERSON COMPLETING FORM <br /> .� PROPERTYOWNER _X ^AGENT OF OWNER <br /> Name <br /> -P'qJ1Mb'qrh Piazza Inc- <br /> Address <br /> CitStreety <br /> State Zip CA 95740 <br /> Phone368-661 A <br /> '� I1I <br /> A. PROJECT DESCRIPTION <br /> '41 1 <br /> 1. Type of application: use Permit, Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, Site Approval, <br /> Q Zone variance, Q Other: <br /> 2. Project location: NE corner of S.Q.R.R. CompnX and Ac o Road at Ac o i <br /> ' Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : Create homesite for <br /> owner/operator <br /> 3 . Total project:ro acreage of 42 <br /> g P ] # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 013-190-24 <br /> 4 . If there is an existing EIR assessing any aspect of <br /> .your project <br /> site, provide title and date: No <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for 'ths project: <br /> r <br /> PERMIT AGENCY <br /> None <br /> ri <br /> t Minor Subdivision - 7 - - ( 6/86 ) <br />