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Environmental Information Form <br /> la-n~t B <br /> DATE: <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 7_7_G <br /> City Low, " <br /> State/Zip C11-r ca c, <br /> Phone %Sty - 7 9 5:� L <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> [] Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> QZone Variance, Q Other: <br /> Z. Project location:/7n ,7/7r4 ���o �,r'� �Q�'z�,n,�o <br /> Describe the project; i .e . , request being made and nature of use . /Y <br /> Identify specific project components : <br /> 4 �s <br /> 3 . . Total acreage of project: ��• � # of existing parcels: <br /> ` Assessor Parcel Us ) : <br /> : on5 - rJ <br /> 4 . If there is anexisting EIR assessing any aspect of your project <br /> site, provide title and date: <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 />