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A� - INN <br /> r: <br /> aur" Environmental Information <br /> For Staff Use Only <br /> File No ._JW Rey- <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 XX PROPERTY OWNER AGENT OF OWNER <br /> Name Joe and Brijida Alvarez , et. al . _ <br /> Address 8606 W. Schulte Road <br /> City Tracy <br /> State/Zip CA 95376 <br /> Phone <br /> TYPE OF APPLICATION Minor Subdivision / ft1Vxfc �� -w-i t y <br /> PROJECT Create a parcel to finance a residence for a member of the <br /> owner/operator' s family who earns a substantial portion of their <br /> income trom farming. <br /> OTHER PERMITS AND APPROVALS (COUNTY, REGIONAL, STATE AND FEDERAL) <br /> REQUIRED FOR THIS PROJECT <br /> PERMIT AGENCY <br /> Percolation Test Health np t <br /> Septic Tank Health nppt, <br /> Well Haalth nept <br /> Building Building Dept <br /> —1— ( 9/85 ) <br /> Plan-44 (12/85) <br />