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Environmental Information Form <br /> Part B <br /> DATE : j1 - 3 - 7 <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 i- R A TO r A Ncz d JAI agliA/ <br /> Address 8797 5 i :nt_ rC RaAL.) <br /> City FRC�njrti NAM 22' <br /> State/Zip C A 9 s a '? i <br /> Phone !3 R � / 7.4E <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> QZone Variance, [] Other : <br /> 2 . Project location: Sou -7)j nr ' A VdrRJ) � 1-H iHeoP RDAs .iUJVCTlon/ I1' <br /> Describe the project; i .e . , request being made and nature of use . <,47prc <br /> Identify specific project components : <br /> `_nL:iQE N1 71 /4 1 SUa 1)iIJiSiLA/ C6riSrSillti� ! G 31n l <br /> 3 . Total acreage of project: S O # of existing parcels : <br /> Assessor Parcel # (s ) : i9 S - 6 2 A R1 4 � 7 0 � 7/ <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: N f4 <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> N A <br /> Major Subdivision - 7 - (6/86 ) <br />