Laserfiche WebLink
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 _C_AGENT OF OWNER <br /> Name X&I O e <br /> Address ZZ 5. Avena fle <br /> City <br /> State/Zip 957-40 <br /> Phone 334 — Co5Z3 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, Q Major Subdivision, <br /> [� Zone Reclassification, N Minor Subdivision, 0 Site Approval, <br /> QZone variance, E] Other: /// <br /> 2 . Project location: 'ZZ 00/ V. TI.-7'jf., o <br /> Describe the project; i .e . , request being made add nature /of use. <br /> Identify specific project compo ents : <br /> TO 3 /� r0/� LI G r! rP7b�/'l �. /7 <br /> -he rhG &r rP ire sem-/Pr!4 . // <br /> 3 . Total acreage of project: # of existing parcels : <br /> Assessor Parcel # (s ) : 617- Z(o O - / <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 /> Minor Subdivision - 7 - ( 6/86 ) <br />