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Environmental Information Form <br /> Part B <br /> DATE :- <br /> (To <br /> ATE : (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 VZAGENT OF OWNER <br /> Name ,p 'elold G <br /> Address 5 O c ✓c <br /> City .S D 11 <br /> State/Zip . v-1 <br /> Phone 4752 - G Z G L <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, El Major Subdivision, <br /> Zone Reclassification, 9 Minor Subdivision, Q Site Approval , <br /> Zone variance, Q Other: / <br /> 2 . Project location:�� Gr/OOr/�'/�e 6:. �Z <br /> Describe the project; i .e. , request beim� made arfd nature of use . <br /> Identify specific project components : <br /> o li /r? 4 J — <br /> OF 4F <br /> 3 . Total acreage of project: BG # of existing parcels : / <br /> Assessor Parcel Us ) :: 013- /45�0- /o <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 /> Minor Subdivision - 7 - ( 6/86 ) <br />