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Environmental Information Form <br /> Part B <br /> DATE: December 23, 1987 <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 CCMPLETING FORM PROPERTY OWNER _ X AGENT OF OWNER <br /> Name Baumbach & Piazza, Inc. <br /> Address 323 Ve--St-77m-7treet— <br /> City Lodi, <br /> State/Zip CA 95240 <br /> Phone 368-6618 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> �--I Zone Reclassification, 0 Minor Subdivision, Q Site Approval, <br /> Q Zone variance, EJ Other: <br /> 2. Project location: Kile Road at Southwest corner of Section 2, T4N, R5E <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : Mr. Arie Den Hartog owns the <br /> home located on property owned by Den Hartog an o Ouse For financinhe <br /> wighns to have his own homeon his own nropertY <br /> 3 . Total acreage of project: 134.4 + # of existing parcels: 1 <br /> Assecsor Parcel # (s ) : 001-260-05 and 07 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: No <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project: <br /> NONE <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />