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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 x PROPERTY OWNER AGENT OF OWNER <br /> Name Elva Gibson <br /> Address P.O. Box 103 <br /> City Clements <br /> State/Zip CA 95227 <br /> Phone (209) 759-3458 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> Zone Reclassification, Minor Subdivision, Q Site Approval, <br /> Zone variance, Q Other: <br /> 2. Project location: West side of Mackville Rd; 3/8 mile south of Liberty Rd. <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : Retain homesite (3 ac) and <br /> sell remainder (141 acres agriculture) <br /> 3 . Total acreage of project: 144 # of existing parcels : 1 <br /> Assecsor Parcel Us ) : 021- <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 /> None <br /> Minor Subdivision - 7 - ( 6/86 ) <br />