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Environmental. Information Form <br /> Part B <br /> DATE: <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 �. ( �, aC`e � 1 CL C-0 <br /> Address _� qi.-K itik. {c h= ie Id r-u . <br /> City �� o��-w <br /> State/Zip r C"'C, 4 <br /> Phone /1.�,�- , /�- c LJ 3 C:--r 1.4; a' - i s <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application : [] Use Permit, Q Major Subdivision, <br /> Zone Reclassification, (" Minor Subdivision, E Site Approval , <br /> Q Zone variance, Q Other : <br /> 2 . Proiect location: -4- file <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : Cn s f Uc <br /> w�Q f f VI e �'::'"C C. _ 1 �2+—f 4 <br /> 3 . Total acreage of project: q-�. Tit. # of existing parcels : 02 <br /> Assessor Parcel # (s ) C' C�'ry_ 60 _ 05 _ C, . <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and dace: <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 />