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Environmental Information Form <br /> Part B <br /> DAT E 71 2!6 <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 3 3 f <br /> City <br /> State/Zip ,c , .f2 4-0 <br /> Phone Zo 3G _ GG�B <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, C4 Minor Subdivision, Q Site Approval, <br /> QZone variance, Q Other : <br /> 2 . Project location: <br /> Describe the project; i .e . , request being made and rfature of use . <br /> Identify specific project components/: of �„ �/ ,fit. Zo 7,4F&J e-YeF- <br /> i"& <br /> 3 . Total acreage of project: O ,4 # of existing parcels : / <br /> Assessor Parcel # (s ) : N - 023- 20 - 2 <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 /> �OKC <br /> Minor Subdivision - 7 - ( 6/86 ) <br />