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tyEnvironmental Information <br /> For Staff Use Only <br /> File No. <br /> Date Filed <br /> APPLICATION FORM PART B: <br /> ENVIRONMENTAL INFORMATION <br /> (To be Filled Out By Applicant ) <br /> NOTE : In completing this form, use additional sheets if necessary. <br /> Answer all questions to the best of your ability. If 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 RICHARD M. BISHOP L.S. <br /> Address 5383 E. FIG AVENUE <br /> City MANTECA <br /> State/Zip CALIFORNIA 95336 <br /> Phone 209)239-3121 <br /> TYPE OF APPLICATION MINOR SUBDIVISION - HOMESITE FOR OWNER <br /> PROJECT SEE ABOVE <br /> OTHER PERMITS AND APPROVALS (COUNTY, REGIONAL, STATE AND FEDERAL) <br /> REQUIRED FOR THIS PROJECT <br /> N/A <br /> PERMIT AGENCY <br /> -1- ( 9/85 ) <br /> ni A A !7'l/n['1 <br />