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Environmental Information Form <br /> Part B <br /> DATE : Oil <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 Tb Se-12k TAyl,+ <br /> Address--a 7S F S +�• ' Srr <br /> City 9 r-e.;n ("A C-A^ o . <br /> State/Zip r_l, . 1 I S Z 3 1 <br /> Phone ('70n q"i ?-S 13 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Zone variance, Q Other : <br /> 2 . Project location: 7 - <br /> Describe the project; i .e . , request being made and n t re of use. <br /> Identify specific project components : C), `l't(Ar_ <br /> 3 . Total acreage of project:) S, # of existing parcels: <br /> Assessor Parcel # (s ) :- 'T <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 /> r J ` ( <br /> Zone Reclassification - 7 - ( 6/86 ) <br />