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Environmental Information Form <br /> Part B <br /> DATE : �elcl ry l`le ; <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 AGENT OF OWNER <br /> Name ^c/ri-P / i9� e 4 /Tse-' 7 <br /> Address e tl n �' I <br /> City AI/f7 L' <br /> State/Zip 6-, - <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, [] Major Subdivision, <br /> Q Zone Reclassification, ER Minor Subdivision, Q Site Approval, <br /> Q Zone variance, Q Other : <br /> 2 . Project location: '�Z Ali-/Z )JO'Af� E)'7- /��v�7-1/Pwd E-/}5/- 4fdz /7uy <br /> Describe the project; i .e . , request being made and nature of use .�� �,� <br /> Identify specific project components : <br /> 3 . Total acreage of project: ,?lam # of existing parcels : 6-Y -Q- <br /> Asse--sor Parcel # (s ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: k10 <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> -P6,-'W 11tteA"L- T'�r 411�n-lam' <br /> Minor Subdivision - 7 - ( 6/86 ) <br />