Laserfiche WebLink
Environmental Information Form <br /> Part B <br /> DATE : I ' <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 KeITg N mtgey <br /> Address ( ztI W. NoetTANK51' NwY <br /> City_ 'Sul re 900 DQu..A[ <br /> State/Zip_ TP LFrS "iS2Z5 <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: E] Use Permit, Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, X Site Approval, <br /> Zone variance, F-1 Other : <br /> 2 . Project location: 11191ylitlr.To Coyt76. F24b"4 fl Cf� <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specificrp/rojectl'components : <br /> ���J�1 sO tett 07'trc�fe. <br /> 3 . Total acreage of project: 4.09 # of existing parcels : <br /> Assessor Parcel Us ) :: 193 . 3b.0Z <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: Nor L2fjoWJ <br /> 5 . Other permits and approvals (County,- Regional. State-and Federa-1) <br /> required for this project : <br /> PERMIT AGENCY <br /> Enic20Aa.kn. LwT S.3E cw��uA4• Wo2�G$A4t^• Wo21GS <br /> Site Approval Application - 5 - (6/86) <br />