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Environmental 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 <br /> R. B. Welty & Associates, Inc. AGENT OF OWNER <br /> Name__ Marvin L. Miller <br /> Address—P.O._B3 1724 --------- ---- -- -- --------_______ _ _ <br /> city---Modes __ --- ----_—.--- <br /> State/Zip_ CA._95353-1724_ <br /> Phone— (209)526-1515 <br /> TYPE OF APPLICATION Minor Subdivision <br /> PROJECT- Minor Subdivision (Parcel map - River Road, South of Escalon) . <br /> OTHER PERMITS AND APPROVALS (COUNTY, REGIONAL, STATE AND FEDERAL) <br /> REQUIRED FOR THIS PROJECT <br /> PERMIT AGENCY <br /> _WL---- -- — N/A <br /> -1- X9/851 <br /> Plan-44 (12/85) <br /> II Gm <br />