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Environmental Information Form <br /> Part B <br /> DATE: 28 December 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 COMPLETING FORM PROPERTY OWNER XX AGENT OF OWNER <br /> Name Jose L. Alva <br /> Address 4505 Pre issi Ln <br /> City Stockton, <br /> State/Zip CA 95207 <br /> Phone (209) 477-6061 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, U Minor Subdivision, Q Site Approval, <br /> Q Zone Variance, Q Other: <br /> 2. Project location:Al2Drox 96 ft South of Washinton St . on Wagner Ave . <br /> Describe the project; i .e . , request being made and nature of use. <br /> Identify specific project components : <br /> To subdivide a 1. 34 acre parcel into four (4) parts and a <br /> Remainder. <br /> 3 . Total acreage of project: 1. 34 # of existing parcels : 1 <br /> Assessor Parcel Us ) : 15T=6+0 <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: N/A <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />