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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 PROPERTY OWNER AGENT OF OWNER <br /> Name 4 /7 Se/"k)Cf- <br /> Address hQ AL V <br /> City <br /> State/Zip <br /> Phone — Z <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Major Subdivision, <br /> Q Zone Reclassification, 5� Minor Subdivision, Q Site Approval, <br /> Q Zone Variance, Q Other : <br /> 2. Project location: O / rah T <br /> Describe the project= i .e. , requ st being made nd natur� ��jj of use.1/ <br /> Ide ify// specific project components : <br /> 7�� <br /> 3 . Total acreage of project: # of existing parcels : / <br /> Assessor Parcel Us ) :: 6:' <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 />