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Environmental Information Form <br /> Part B <br /> DATE : Z49- 8 9 <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 PROPERTY OWNER _AGENT OF OWNER <br /> S6is 45L. <br /> Address 'ZZ¢ S. AVC-NA E . _ <br /> City Z-OPI <br /> State/Zip O <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, [:] Major Subdivision, <br /> Zone Reclassification, X Minor Subdivision, [:] Site Approval, <br /> Zone Variance, Q Other: <br /> 2. Project location: /INOrr,6W& 6rjAr- 611/PI- RQ199 <br /> Describe the project; i .e. , request being made and nature of se . <br /> Identify specific project comp vents : VIVIOE 3. In�-& "4s <br /> 4 G LS o 1- 3, AZ <br /> IND115T2/A-L <br /> 3 . Total acreage of project: 3.Z # of existing parcels : <br /> Assessor Parcel # (s ) : q0S •- / • 2/ 005 - 0,90 - 37 <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 />