Laserfiche WebLink
Environmental Information Form <br /> t <br /> Part B <br /> DATE : nec-Pmhar 280 19,87 <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 X PROPERTY OWNER AGENT OF OWNER <br /> Name Thomas Blackmun and Nancy Blackmun <br /> Address Alice Road , North of Veritas Avenue <br /> City Manteca <br /> State/Zip California 95336 <br /> Phone N/A _ <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, Q Major Subdivision, <br /> Zone Reclassification, �X Minor Subdivision, Q Site Approval, <br /> Zone Variance, Q Other : <br /> 2 . Project location: Northwest corne,- of Veritas and Alice Road <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : Parcel for single family <br /> residential hn.i.se <br /> 3 . Total acreage of project: 29 . 54 # of existing parcels : one <br /> Assecsor Parcel # (s ) : 243-170-41 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date : N-)nP <br /> 5 . Other permits and approvals (County, Regional , State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> We1T permit San oaquin Local Health <br /> Septic permit San Joaquin Locai Healtn <br /> erco ation test permit San Joaquin Local Health <br /> Building permit San Joaquin County Pianning ep . <br /> 7—uilding District ) <br /> Minor Subdivision - 7 - ( 6/86 ) <br />