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� 4 <br /> Environmental Information Form <br /> Part B <br /> DATE : e l �� <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 can of be accepted. <br /> PERSON COMPLETING FORM PROPERTY OWNER AGENT OF OWNER <br /> Name (�Pxlle peell- <br /> Address <br /> S /1 ,Os 7+- <br /> C i t yr,��r c e-- <br /> State/Zip cid <br /> Phone yl -p OP E <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, 0 Major Subdivision, <br /> Zone Reclassification, Kminor Subdivision, Q Site Approval, <br /> Zone Variance, Q Other : <br /> 2 . Project location: <br /> Describe the project; i .e . , request being made and nature Ut use . <br /> Identify specific project components : <br /> /ir .4,v =X/sT/.y6 <br /> ,M(AC Z S 2SO4 #66 AD f Q 7-/.4 4 6',-SO <br /> 3 . Total acreage of project: # of existing parcels : <br /> Assessor Parcel # (s ) : — /9:?-1r'?0?0 "/a <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: <br /> . 5 . Otheripermits and approvals (County, '�Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />