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. - Environrner,.al InformationForm <br /> Part B <br /> DATE : 9-20-88 <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 XX PROPERTY OWNER AGENT OF OWNER <br /> Name Robert Van Ruitan <br /> Address_361 E. HarnP_ T ane <br /> City_ ).odi_ <br /> State/Zip CA 95240 <br /> Phone 209-334-1095 <br /> A. PROJECT DESCRIPTION <br /> I. Type of application : Q use Permit, Q Major Subdivision, <br /> Zone Reclassification, 0 Minor Subdivision, 0 Site Approval , <br /> Zone Variance , Q Other : <br /> 2 . Project location : 361 E. Harney Ta_np__ <br /> Describe the project; i .e . , request being made_and nature__ of__use___. <br /> Identify specific project components :—Retain an existing homesite from <br /> a 30 awe agrir„1 tural parcel <br /> 3 . Total acreage of project : 29.2 # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 058-040-03 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : N/A <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> N/A <br /> Minor Subdivision - 7 - ( 6/86 ) <br />