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Environmental Information Form <br /> Part B <br /> DATE : <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 Tl z- Vc,LC� S <br /> Address 5.2d� ICY,, <br /> City <br /> State/Zip <br /> Phone -7 - I <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, E] Major Subdivision, <br /> Zone Reclassification, Q Minor Subdivision, Q Site Approval, <br /> Zone Variance, Other: f/Lg: <br /> 2 . Project location: 7c 5` V /C7e-.(,"-,r L(^,fi 14 LL- <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify_ specific project comp <br /> 'o/nents : <br /> o <br /> 3 . Total acreage of project: 42 , 7f # of existing parcels : �- <br /> Assecsor Parcel Us ) <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 />