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Environmental Information Form <br /> Part B <br /> DATE : DG 7 Z S /,989 <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 PROPERTY OWNER AGENT OF OWNER <br /> Name <br /> Address Z <br /> City Low <br /> State/Zip 4f;2/„/ gsz4o <br /> Phone 3Gg - GG /B <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, F4;7f Minor Subdivision, Q Site Approval, <br /> [-] zone variance, [:] Other : <br /> 2 . Project location71 fir �,/,�;,��„ _ 2�a� '.r>v•�� ����A�� �� <br /> Describe the project; i .e. , request being made and natu a of use . <br /> Identify specific project components : <br /> 3 . Total acreage of project: -5' # of existing parcels : 2 <br /> Assessor Parcel # (s ) :-- A.811- OZ/- 044 - Zo <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: — <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 />