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Environmental Information Form <br /> Part B <br /> DATE : A bl G S <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 COMPUTING FORM _PROPERTY OWNER AGENT OF OWNER <br /> Name b C> F tZT ��S6 Cy r <br /> Address / Q c ( r , � c� F> o ctop t2 L_ 1 5� <br /> _ (� <br /> City _STDG KTo A: <br /> State/Zip r'q Ct r, O <br /> Phone_ 46- 2- - <br /> A. <br /> 6- Z. -A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Site Approval , <br /> QZone Variance, ❑ Other : <br /> 2 . Project location: PGp 2- PPF R 2- 20 LI S <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components :_ t4cLis „`jC �t jDoC—S <br /> 3 . Total acreage of project: y` , c? 3 of existing parcels : / <br /> Assessor Parcel # (s ) : /p,5— G G — 2 %- 5 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provider title and date : M6 tit F- <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> r r ri er I pce�Li ( VCM G <br /> Site Approval Application - 5 - ( 6/86 ) <br />