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Environmental Information Form <br /> Part B c <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 —XPROPERTY OWNER AGENT OF OWNER <br /> Name ti'ti/ C/- X 1:L1 SV. JE'i <br /> AddressZ- <br /> Cit y ci <br /> State/Zip ! -Z- <br /> Phone -1 ;- � " <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Site Approval , <br /> Zone Variance, Other: <br /> 2 . Project location: ��� �T�t��•�� /'Lti��' <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific_ project components : <br /> 3 . Total acreage of project: # of existing parcels : <br /> Assessor Parcel # (s ) : <br /> 4 . If there is an existing EIR assessingg any aspect of your project <br /> site, provide title and date. NL' <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for --thisvproject:' <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />