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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 COMPLETING FORM PROPERTY OWNER X AGENT OF OWNER <br /> Name Loren Perry <br /> Address 1225 E. Acampo Road <br /> Cit y Acampo <br /> State/Zip CA 95220 <br /> Phone 368-9135 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, M Minor Subdivision, E] Site Approval, <br /> QZone Variance, Q Other : <br /> 2 . Project location: 250 E. Ploodbridge Road, Woodbridge, CA <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : Create two sinp-le family and <br /> duplex lot. <br /> 3 . Total acreage of project: 0.62 # of existing parcels: 1 <br /> Assessor Parcel Us ) :: 015-072-25 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: No <br /> I 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> County Building Permit San Joaquin Coun , <br /> Public Works San Joaquin County <br /> Health San Joaquin County <br /> hater San Joaquin <br /> Sewer Woodbridge Sanitary District <br /> Minor Subdivision - 7 - ( 6/86 ) <br />