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- Environmenta, information Form <br /> Part B <br /> DATE: May 27, 1987 <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 /> X <br /> Name MID-VALLEY ENGINEERING, INC. <br /> Address P.O. Box H Street <br /> City Modesto <br /> State/Zip California 95353 <br /> Phone (209) 526-4214 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application : Q Use Permit, E] Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivi4ion, Q Site Approval , <br /> Zone Variance, Q Other : <br /> 2 . Project location: 30941 S. Roster Road <br /> Describe the project; i .e. , request being made and r:ature of use . <br /> Identify specific project components : The proposed minor subdivision <br /> will create three new homesties with acreages of not less than 1.5 acres each. <br /> 3 . Total acreage of project: 5 # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 255-110-54 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : Not applicable <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> Not Applicable <br /> Minor Subdivision - 7 - (6/86 ) <br />