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Environmental Information Form <br /> Part B <br /> DATE : 71Zo <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 <br /> //FORM <br /> // PROPERTY OWNER AGENT OF OWNER <br /> Name So In /L O 0"/Ica <br /> Address oo r /i Ga <br /> City Ml�s� ecce <br /> State/Zip <br /> Phone 99Z - 51t6 :5 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: use Permit , 0 Major Subdivision , <br /> 7. zone Reclassification, [D Minor Subdivision, Site Approval , <br /> Zone variance, E] Other : f� / <br /> 2 . Project location: Z&-O FI"Pf7Cl7 CC!/Ylp K&?/ , /a/J7��CGt. <br /> Describe the project; i .e . , request bein4 made artid nature of use .// <br /> Identify speSSific project /components :-MW A eoo/^r,7ri Ue <br /> 17 � EX/Sf/✓ y�llylL'Y'10/� - TrG�ct ____ <br /> 3 . Total acreage of project:" N of existing parcels : Z <br /> Assessor Parcel U (s ) : /77- 090 - .34 /99 - /ZO — 09 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: /VO <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 />