Laserfiche WebLink
Environmental Information Form <br /> Part 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 <br /> �i PROPERTY OWNER -AGENT OF OWNER <br /> Name 12 e /l . 'Selib c'/ <br /> Address Z Vft V—E:!— <br /> city Lo <br /> State Zip <br /> Phone — S <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Minor Subdivision, Q Site Approval. , <br /> E__l Zone variance, Q Other : <br /> 2 . Project. location: 1-f 17 lIL RCZ <br /> Describe the project; i .e . , request be ' ad and ature of u e . <br /> Id,enAify spec ' f is poject ompo a is : V ?77 l <br /> 3 . Total acreage of project # of existing parcels : <br /> Assessor Parcel # (s ) : (- <br /> 2 J -- / 9 O 2 o Z -3 <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 />