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Environmental Information Form <br /> Part B <br /> DATE :may l ' 1 9Rq <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 X AGENT OF OWNER <br /> Name Nirho s, Melburg & Rossetto, AIA, Architects <br /> Address :ZQda Madison Ave. , Suite 150 <br /> City Fair Oaks. California 95628 <br /> State/ZipCal ifornia, 95628 <br /> Phone _(916) 967-1340 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: 0 Use Permit, Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, 0 Site Approval , <br /> Zone Variance, Q Other : <br /> 2 . Project location: Northland Road, 12006 east of Highway 99 frontage road. <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : Phase I, a 25,828 sf church meetinghouse <br /> with 26 parking spaces surrounded by a lighted .and landscaped parking lot. Phase II <br /> a 14,600 sf church meetinghouse with an additional 106 parking spaces. <br /> 3 . Total acreage of project: 11.53 # cf- existing parcels : 1 <br /> Assessor Parcel Us ) :) 147-100=A1 <br /> 4 . If there is an existing EIR assessing any aspect of ycur project <br /> site, provide title and date :_ NQnp <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> None <br /> Use Permit Application - 7 - ( 6/86 ) <br />