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Environmental Information Form <br /> Part B <br /> DATE : ( - 7 - 89 <br /> (To be Completed By Applicant ) <br /> NOTE : In completing this form, use additional sheets if necess4ry . <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 AV1 4"o L ;.ted <br /> Address • o• ox //6 / <br /> City <br /> State/Zip CAJ, ,4 9SZ 37 <br /> Phone 76-3- SS8 2 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Major Subdivision, <br /> Zone Reclassification, D� Minor Subdivision, Site Approval , <br /> Zone Variance, Q Other : _W' <br /> 2 . Project locatior.. / aZ <br /> Describe the project; i .e . , re uest beimade and nature of use . <br /> Identify specific project components : �bllyl <br /> d1 �icul /:01A <br /> o.G$ <br /> 3 . Total acreage of project: of existing parcels : / <br /> Assessor Parcel # (s ) : - _; Def --4;'&0 - o S <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 /> •SAS:�..�.� �vJa�i� �o�4n - Lv��c��Co�,..• .��✓.� /'�r <br /> Minor Subdivision - 7 - ( r/86 ) <br />