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DATE • 'i - I$_ iL <br />EnvironmerILal Information Form <br />(To be Completed By Applicant) <br />Part B <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 <br />Addres <br />Ci <br />St <br />Ph <br />A. PROJECT DESCRIPTION <br />1. Type of application: Q Use Permit, Q Major Subdivision, <br />zone Reclassification, Q Minor Subdivision, Q Site Approval, <br />zone variance, D Other: <br />2. Project location: Qncr of i;Na Kp p. 170cVt Sc rN4 M«raN <br />Describe the project; i.e., request beingmadT a and hature of use. <br />Identify specific project components: 7 LLT r PLAL �.rso,v s,ani <br />3. Total acreage of project: 12.114A # of existing parcels <br />Assessor Parcel Y(s): pgj_oy_ ry <br />4. If there is an existing EIR assessing any aspect of your project <br />site, provide title and date:Abm 4. <br />5. Other permits and approvals (County, Regional, State and Federal) <br />required for this project: <br />Major Subdivision <br />- 7 - <br />(6/86) <br />T <br />