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Environmental Information Form <br /> Part B <br /> DATE : /S -87 <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 /> NameZa <br /> Address 323 r-01 <br /> City o ; <br /> State/Zip /,i/ ?JrZ,�,c� <br /> Phone 3G8 -66 B <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Z Minor Subdivision, 0 Site Approval, <br /> Zone variance, Q Other : <br /> 2 . Project location: 2200 e"). <br /> Describe the project; i.e . , request being made and nature of use . <br /> Identify specific project components :_ Z•— A�-r-,fts <br /> !3 . <br /> 3 . Total acreage of project: t # of existing parcels : <br /> Assecsor Parcel # (s ) :_ MS'S- 22 —a ¢- <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 />