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Environmental Information Form <br /> Part B <br /> DATE : .4_ � <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 � <br /> Address 4.5 <br /> City <br /> State/Zip 1:5-51051 Sao <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Use Permit, Q Major Subdivision, <br /> Zone Reclassification, K Minor Subdivision, E Site Approval , <br /> Zone variance, Q Other : <br /> 2 . Project location: �� e � <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : C' ';�& --.-7 e-,, <br /> 3 . Total acreage of project: U # of existing parcels : <br /> Assessor Parcel # (s ) :- /0.3 -020-// <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: V"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 /> .- ' ... !?tidl,sn.,1{�;i:'> '43r+1�!"at.•:y; R:re,,... , ,w.-Nigh l fe l 4.}M a, �w✓.sitdnfii:4•t°��fa' L FwitMlkl�tdtil `�r4r <br />