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Environmental Information Form <br /> Part B <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 FORMPROPERTY OWNER -AGENT OF OWNER <br /> Name { ,,�0 E7 M X1 1 Ll_A U H EVA <br /> Address P, 9 ( A -? A LFA ST�F.FT <br /> City R k PLLA <br /> State/Zi 3 <br /> Phone �Q� �qCT - G 37 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, � Minor Subdivision, Q Site Approval, <br /> QZone variance, Q Other : <br /> 2 . Project location: 1-�WX (20 E \NA(;,RE-P, R-O&D FIPON-A PEA <br /> Describe the project; i .e . , request being made and nature of use . <br /> Ide tify specific project components : <br /> e <br /> 1 <br /> r^ .t /` S <br /> f <br /> 3 . Total acreage of project: "3-7.,4' # of existing parcels : <br /> Assessor Parcel # (s ) :- 2G-5 -O`1 - Q J <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: /� /A <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> No N c-:' <br /> Minor Subdivision - 7 - ( 6/86 ) <br />