Laserfiche WebLink
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 x PROPERTY OWNER AGENT OF OWNER <br /> Name John D & Monda Bernd <br /> Address P . 0 . Box 301 <br /> City CIPmantG rA <br /> State/Zip <br /> Phone 759-3662 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> QZone Variance, [2 Other: R ; aht of Wav <br /> 2. Project location: Kroll Rd <br /> Describe the project; i .e. , request being made and nature of use. <br /> Identify specific project components: <br /> Want to build home <br /> 3. Total acreage of project: # of existing parcels: <br /> Assessor Parcel # (s ) : 051?i 52 <br /> 4. If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: NO <br /> 5. Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> N/A <br /> Private Rights-of-Way -7- ( 8/86 ) <br />