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Environmental Information Form <br /> Part B <br /> DATE : is <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 /( J <br /> Address '1 <br /> City <br /> State/Zip(,,t <br /> Phone ;� ,, ' ti <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application : Use Permit , Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, F] Site Approval , <br /> Zone Variance, Q Other - <br /> 2 . Project location: y ( 0) h.")J/ <br /> Describe the project; i .e. , request being made and nature of use . <br /> ,Identify specific project components : 'JI( <br /> ` Iru` 1Al ( 14f 1`,CJ� i r ni" W(I( I' t r << �1 / i r,'•;, i <br /> till'` <br /> U, <br /> 3 . Total acreage of project : /"- - '')'� # of existing parcels : <br /> Assessor Parcel # (s ) : ( ' "(-_( <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 /> General Plan Map Amendment 11 (6-86 ) <br />