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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 formscannotbe accepted. <br /> PERSON COMPLETING FORM PROPERTY OWNER y� AGENT OF OWNER <br /> Name L 4ft MQ ?� <br /> Address . v . 1 <br /> City IGH C M9 <br /> State/Zip C Z "5 <br /> Phone <br /> A. PROJECT DESCRIPTION C PRE Arp LI CAM by-' <br /> 1 . Type of application : � Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, X Site Approval , <br /> Zone Variance, Q Other : <br /> 2 . Project location: '320 V�4q�Gq (!*(p 9D <br /> Describe the project; i .e . , request bemade and nature of use . <br /> in <br /> Identify specific-Project components : Sire <br /> VLA--ri Ebo- F(Ze-1-4c <br /> / e <br /> mac,It So v-- <br /> 3 . Total acreage of project: � # of existing parcels : <br /> Assessor Parcel # (s ) : 1 0 - 08 <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 /> Fi N Art. USE VMm%r- —<;�—, �, Lo <br /> GINA.. SLT& CSL 5. T Ga. <br /> Use Permit Application - 7 - ( 6/86 ) <br />