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Environmental Information Form <br /> Part B <br /> DATE : /D�LSfBfJ <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 2• l� �/� �r/�� r �.f�OG. � �.' �S�e `lG.r� /��is7�cvf <br /> Address ¢d 4---!r mere `a o 1411G <br /> City _ Stec,L� i <br /> State/Zip CX 9s2-e¢ <br /> Phone 9¢3-1ez/ <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, [g] Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> QZone variance, Q Other: <br /> 2 . Project location: <br /> Describe the project; i .e . , request bein made'and nature of use . <br /> Identify specific project components : _9 '-ac <br /> /�1/0 1,7 <br /> Co�n ns ts�i� r I��uld74i Ld �e�i ' <br /> 3 . Total acreage of project: of existing parcels : <br /> Assessor Parcel # (s ) :- leS-/7o - /- z! 3y 1'¢/ <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date :— ,,-6/e. <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT ' JJ AGENCY <br /> Major Subdivision - 7 - (6/86 ) <br />