Laserfiche WebLink
Y Environmental Information Form <br /> Part B <br /> DATE: l�)nV-2q �9 <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 �ROPERTY OWNER AGENT OF OWNER <br /> Name -2v a-e d Fk► LL P s <br /> Address 12,2 99 S uo b(ZD <br /> City no&',-r -cZ <br /> State/Zip C aL.-C . cl 33� <br /> Phone 20g ) SRS A - 2Lo9Ln <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Use Permit, Q Major Subdivision, <br /> Zone Reclassification, X Minor Subdivision, Q Site Approval, <br /> Zone Variance, Q Other : <br /> 2 . Project location: ,25b(n cof5L6o <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : 1 '/2 (aCEQ S <br /> -FY-om 25 �c2-� fae Sows <br /> 3 . Total acreage of project:_ f2 # of existing parcels: ZS <br /> Assessor Parcel # (s ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: No. <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> mbv4 <br /> Minor Subdivision - 7 - ( 6/86 ) <br />