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14 <br /> • Environmental Information Form <br /> Part B <br /> DATE: <br /> i <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 v , PROPERTY OWNER AGENT OF OWNER <br /> Name 'T4/gE.S 5. :S4,54K l <br /> Address 2CC2l ti_ Kcti'NE�tc« <br /> City A(-,Iq Ti Tc <br /> State/Zip Cr?GIor-'c'A tA)64 <br /> Phone ( 2 Jq) WR-,S-C73 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Site Approval, <br /> Zone variance, Q Other : <br /> 2 . Project location: /�%;� CrC�'6n' �C�N� � 1�K 3' l CL'��rr_'ik r`/ ,rte <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : S'L'13-1)), <br /> f { 'r� , t�a r L CZ A;ri ti i,vL pi,�,c,c <br /> 3 . Total acreage of project: 45"r t # of existing parcels : <br /> Assessor Parcel Us ) ::_ /7-/ -S- <br /> - 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: V /� <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 />