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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 <br /> AGENT OF OWNER <br /> Name 5/�Al Jo I-P a u IA.,, co v.vr r pC /a 0L.'A.,11 Al- <br /> Address- /,110 E. N,gzce7v.- t9-C <br /> City S 704rlc TD A-, •. <br /> State/Zip c,Q Z 1r dtz .�i.9 <br /> Phone 1 oq) y6A -.t/20 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, E] Site Approval , <br /> Zone variance, Q Other : <br /> 2. Project location: // 7i L. 1<E77LLZr19 ., LAS£ I c9 175-2 YU <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : JL zoyC APA," 65-1 <br /> 1=T 01- G-12 L TD C,,4- YO. <br /> 3 . Total acreage of project: of existing parcels : O wf <br /> Assessor Parcel # (s ) os-1 - 2.OV- 2-y <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 /> "kic AIF <br /> Zone Reclassification - 7 - ( 6/86 ) <br />