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DATE: ti -A-8 <br />Environmental 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 />Addr <br />City <br />Stat <br />Phon <br />A. PROJECT DESCRIPT <br />1. Type of application: Q Use Permit, [E Major Subdivision, <br />Q zone Reclassification, Q Minor Subdivision, Q Site Approval, <br />zone variance, D Other: <br />2. Project location: encr of r Na j�p &� /7cn /i{, mN RAO <br />Describe the project; i.e., request being made and ature of use. <br />Identify specific project components: '7 L<r r2,nnc S rsa v s,.w <br />3. Total acreage of project: /2.;0/4G # of existing parcels: <br />Assessor Parcel # (s) :Q43 .,> y _ 17-- <br />4. <br />7-- <br />4. If there is an existing EIR assessing any aspect of your project <br />site, provide title and date: V.,,,,z <br />5. Other permits and approvals (County, Regional, State and Federal) <br />required for this project: <br />PERMIT AGENCY <br />Major Subdivision - 7 - (6/86) <br />