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Environmental Information Form <br /> Part B <br /> DATE : ��Z�f9 7 <br /> T <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 zpwmZ-0e-`i 4t /.q z-2 a. <br /> Address 3 Z3 E/'w J <br /> City z4->r/) <br /> State/Zip /- 9S2 Vo <br /> Phone 21:118— GLIB <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Major Subdivision, <br /> Q Zone Reclassification, Minor Subdivision, Q Site Approval , <br /> Zone Variance, Q Other : <br /> /fsi.rr12, <br /> 2 . Project location:_E hf A*V4 A6�1- YJ /h•G Casee .� <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : <br /> 3 . Total acreage of project: eo ypc # of existing parcels : / <br /> Assessor Parcel Us ) ::_ OG.3-/1—/G e17 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: A)v <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 />