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Environmental Information Form <br /> Part B <br /> DATE • 9 0��� <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 C---PROPERTY OWNER AGENT OF OWNER <br /> Name <br /> Address SQS �1H�T�A ST/�G�T <br /> City 1--)'igy7Z-5 <br /> State/Zip G'.Q, 95336 <br /> Phone 720 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Major Subdivision, <br /> Q Zone Reclassification, 'Minor Subdivision, Q Site Approval., <br /> [:J Zone variance,E] Other- <br /> 2 . Project location:1512/O S/.t�T,. <br /> Describe the project; i.e. , request being made and nature of use . <br /> Identify specific project components : <br /> i <br /> 3 . Total acreage of project• # of existing parcels: <br /> Assessor Parcel # (s ) : --'2�' - - .2 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide titleland date: AfOA)C <br /> i <br /> 5. Other permits and appro als (County, Regional, State and Federal ) <br /> required for this proje t: <br /> I <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - (6/86) <br />