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Environmental Information Form <br /> Part 6 <br /> DATE : lU - Z U - <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 X PROPERTY OWNER X _AGENT OF OWNER <br /> Name <br /> Address z 2 5. ek- c� Z <br /> City i_ - <br /> State/Zip 9 r <br /> -1111-0 <br /> Phone '? - L_ .3 - ZIA to) <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application : use Permit , Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> QZone Variance, Q Other : / <br /> 2 . Project location: �(' �� C ,JCl /7C,1A77Z// /CCS' A-42,22 /- <br /> Describe the project; i .e . , request being made an nature of use . <br /> Identify specific project components : <br /> 3 . Total acreage of project : ;?.Q # of existing parcels : / <br /> Assessor Parcel Us ) :: o `> - / 7 C% - 0 / <br /> 4 . If there 'is an existing EIR assessing any aspect of your project <br /> site , provide title and date: A/C? <br /> 5 . Other permits and approvals (County, Regional, . State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 ( 6/86 ) <br />