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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 Co r I L( I <br /> Address <br /> City L-I r)(101-) <br /> State/Zip Co, qS 2-3-6- <br /> Phone <br /> 36Phone gK 7 - snL4J <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application : Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval , <br /> Zone Variance, 2 Other : Q I' CCA rJUra 1 0 1Y e S1-t? <br /> 2 . Project location: 6,6 1 E� -HL I�(I ('L) , <br /> Describe the project; i .e . , request bei made and nature of use . <br /> Identify specific project components : �'lC)j 1l(� SIie <br /> 3 . Total acreage of project:( r s# of existing parcels : <br /> Assessor Parcel # (s ) : 0(o7 - (30 _- d 1 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: Y)0 <br /> S . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT1 AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />