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a , <br /> 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,w Gar aura Ccsvt rcy p`amu,Ntr C;lvtStc'� <br /> Address <br /> City <br /> State/Zip C-4, 9 'Z -Z-�7 <br /> Phone 4-b`Q • 3�zo <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval , <br /> QZone variance, Q Other : <br /> 2 . Project location: See- M Ae <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : <br /> 3 . Total acreage of project: 1-7 ktAQ# of existing parcels: Z7 <br /> Assessor Parcel Us ) :: 5en-,- L�Sc- <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 /> Zone Reclassification - 7 - ( 6/86 ) <br />