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Environmental Information Form <br /> Part B <br /> DATE :-TI/1gl{ 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 /> Name <br /> Address Pn 3DX �;l -i <br /> City 1-:;4-c7�r_1<�-nr� <br /> State/Zip CA 45201 <br /> Phone ( ZQC4) i.._}(05- CDe3 I <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, N Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q. Site Approval , <br /> Q Zone Variance, E] Other : AmFrY�lY�n'�- <br /> 2 . Project location:W(nh\n.;rk\t 33 pi- -Li(ri-w-in Rcry and Kr �r- <br /> Describe the projec ; i .e . , request being made dLnd nature of use . <br /> Identify specific project components : A 21n )r-+ <br /> rmSi cie= -)�-i nLlS�_a�ii�ri�i�r l ? - �c re-- <br /> 5i 4-e,=, <br /> 3 . Total acreage of project:,�Sf, 6 # of existing parcels: i <br /> Assessor Parcel Us ) ,:= 2 r,-Z::; - I�0 - of <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, Aegional, State and Federal) <br /> required for this project : <br /> PERMIT AGENCY <br /> Zone Reclassification - 7 - ( 6/86 ) <br />