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Environmental Information Form <br /> Part B <br /> DATE : <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 �7�, n 5. S;r, c f��✓ <br /> City Stoc <br /> State/ZipCa. orn;a q 5� T <br /> Phone q43-128 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: 29 Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Site Approval, <br /> Q Zone variance, Other: <br /> 2 . Project location: _ �� % % ,'.�! rtr E lw'i �OSQ CCd / <br /> Describe the project; i .e . ; request being' made an nature of use . <br /> Identify specific project "components :— /- c -ko <br /> 3 . Total acreage of project: #� of existing parcels : <br /> Assessor Parcel # (s ) :--"---7 <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 /> Site Approval Application - 5 - ( 6/86 ) <br />