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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 X_PROPERTY OWNER AGENT OF OWNER <br /> Name DOUGLAS H . WINN <br /> Address P . O . BOX 24 <br /> City LOCKEFORD <br /> State/Zip CALIF . , 95237 <br /> Phone ( 209 ) 727-5531 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: ❑ use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Zone Variance, Q Other : <br /> 2 . Project location: 1gO06 N _ JACK TONE RD . , 19655 & 19609 N . COTTON ST . <br /> Describe the project; i .e . , request being made and nature of use tOCKEFC <br /> Identify specific project components : <br /> NONF <br /> 3 . Total acreage of project: . 728 # of existing parcels : 3 <br /> Assessor Parcel # (s ) p1q-020-4g- 11 / 12 . 019-020-51 - 11 / 12 , 019-020-52- 11 / 12 <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 /> NONE <br /> General Plan Map Amendment 11 ( 6-86 ) <br />