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Environmental Information Form <br /> Part B <br /> DATE: 02-25-89 <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 THOMPSON HYSELL ENG . <br /> Address 1016 12th <br /> City <br /> State/Zip CALIFORNIA . 95354 <br /> Phone 209-521 -8986 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Xl Minor Subdivision, Q Site Approval., <br /> QZone Variance, Q Other: <br /> 2 . Project location: 12475 S . VAN ALLEN ROAD <br /> Describe the project; i.e. , request being made and nature of use. <br /> Identify specific project components : SINGLE FAMILY HOME <br /> ON TEN ACRE PARCEL . <br /> 3 . Total acreage of project: 158 # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 205- 130-01 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: NONE <br /> 5. Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> NONE <br /> Minor Subdivision - 7 - (6/86 ) <br />