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Environmental Information Form <br /> Part B <br /> DATE : 22 ZAQ 8 fj <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 /> Name611 ZSG <br /> Address �L <br /> City <br /> State/Zip <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> E] Zone Reclassification, Minor Subdivision, Q Site Approval, <br /> E] Zone variance, Q Other: <br /> 2 , Project location: 2201 Gj- ( Wt�;25 ['L� — COY( 953�7� <br /> Describe the project; i .e. , request being made and rfature of use . <br /> Identify specific project components : O <br /> run <br /> 3 .. Total acreage of project: + # of existing parcels : <br /> Assecsor Parcel # (s ) : 2 -_25o — <br /> 4 , If there is an existing EIR assessing a 2y aspect of your project <br /> site, provide title and date: d <br /> S • Other permits. and approvals (County, Regional , State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> N�Ll <br /> Minor Subdivision - 7 - ( 6/86 ) <br />