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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 X AGENT OF OWNER <br /> Name A laIJ6 elVl IAJ1G- <br /> Address 4."5a Irl---4 Cl 1 EOQ SIJ/jam <br /> City STOGL'TO�1 <br /> State/Zip G9 zp5Zo7 <br /> Phone 4212 00// <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Minor Subdivision, Q Site Approval, <br /> QZone Variance, Q Other: <br /> 2 . Project location: //fid AIA1/7,1- LAA-�e <br /> Describe the project; i.e. , request being made and nature of use. <br /> Identify specific project components : <br /> 2 1-07 P-4 ec L MAP Lo7s 14ZAIIA,761 l /u2,OOD :?F <br /> 11 1 <br /> 3 . Total acreage of project: •LOO # of existing parcels : / <br /> Assessor Parcel Us ) :: /o/- <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: ,t/OAJe <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> ��G �tilAP �OIJ�tl7Y <br /> Minor Subdivision - 7 - ( 6/86 ) <br />