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Environmen♦ -1 Information Form <br /> Part B <br /> DATE : (0 <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 X PROPERTY OWNER AGENT OF OWNER <br /> Name To&kL( G2-R,-A, <br /> Address 1(1522 S VM11t &I-L-Dx V-r% <br /> C. City -��,�►-t <br /> State/Zip_ G4 qS3-CID <br /> Phone Q?,Q— Z ( R(C) <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application : Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Minor Subdivision, Q Site Approval , <br /> Zone variance, E] Other : <br /> 2 . Project location: I (Q 7-2- S, \Jay, ItuAaa CL.nA-T�,._ k C�4 <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components :_ -DIo"DE 41 ,o4 &aP c►-tTr-� <br /> 2 P.kcz L e L.s ' ?A-a zL- A TD Gv_►tel(( Aa 14 -�a . 0a n FS. <br /> 3 . Total acreage of project: # of existing parcels : <br /> Assessor Parcel # (s ) :-los - 2�D-D-ri <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: (\((.� 4112 <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 />