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Environmental Information Form <br /> Part B <br /> DATE : /'�Pr/� 4j /g 90 <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 945&/ SD T',L---Z-0 <br /> Address f _3 797 N, ,rFAAlE S/G(-- <br /> City $C�, 'ro <br /> State/Zip c y jSZZo <br /> Phone T6-4— $6 34- <br /> A. <br /> ¢A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, g Site Approval, <br /> Q Zone variance, Other: / <br /> 2 . Project location: 2 S.T70 �l/, f�►�j! 44 , W, laren7'uae <br /> Describe the project; i .e . , request bei'ng made and nature of use . <br /> Ide of spec f project components : Cor/frtac�or 's O ce <br /> a r-u e <br /> 3 . Total acreage of project: A0 Ac-, of existing parcels : 3 <br /> Assessor Parcel Us ) :: too--r- lgl - /" <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : 11//t7 <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> G/O — <br /> b <br /> Site Approval Application - 5 - ( 6/86 ) <br />