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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 AGENT OF OWNER <br /> Name S'o lel <br /> Address 2 Al <br /> City Aca^l <br /> State/Zip C lq q SZ Z o <br /> Phone 46� — KD 3 C{ <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, 0 Minor Subdivision, Z Site Approval, <br /> Q Zone variance, Q Other : <br /> 2 . Project location: ZS S70 Al f{UJ n <br /> Describe the project; i .e . , request being maAe and nature f use . <br /> Identify specific project components : -Av- kh Sale- ep,,A/ <br /> 3 . Total acreage of project: A # of existing parcels : 3 <br /> Assessor Parcel # (s ) : ODS —/i4/ <br /> 4 . If there is an existing EIR assessin any aspect of your project <br /> site , provide title and date : it/a <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> Site Approval Application - 5 - ( 6/86 ) <br />