Laserfiche WebLink
Environmentat 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 AGENT OF OWNER <br /> Name WDrd <br /> Address 7� - � J <br /> City <br /> State/Zip_ <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Major Subdivision, <br /> Zone Reclassification, 51 Minor Subdivision, [] Site Approval , <br /> Zone variance, Q Other: <br /> 2 . Project location: <br /> Describe the project; i.e. , request being made and nature of use. <br /> Dly(Q F <br /> Identify specific project components : Ey' <br /> XtS�ltil�r- <br /> F40 VS C7F R Q �ry1 TF�E �.R N C t-1 �4 R-- uJ N E S <br /> N KrosOF TRE <br /> 3 . Total acreage of project: 44 0 # of existing parcels: <br /> Assessor Parcel US ) :: 0 lel Dib O 19 - 110 <br /> 4 . If there is an existing EIR assessi g any aspect of your project <br /> site, provide title and date: <br /> 5 � Other permits and _approvals (County, Regional, <br /> State and Federal) <br /> required for this project: <br /> PERMIT AGENCY <br /> 7 ( 6/86 ) <br /> Minor Subdivision <br /> - <br />