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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 Bawnhach � Piazza Inc. <br /> Address 323 West Elm Street <br /> City Lodi <br /> State/Zip CA 95240 <br /> Phone 368-6618 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, EJ Minor Subdivision, Q Site Approval , <br /> Q Zone variance, [] Other : <br /> 2. Project location: South side of Peltier Road, 700' East of Davis Road <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : <br /> Separate parcel for Owner's homesite <br /> 3 . Total acreage of project:_ 27.3 ± # of existing parcels : 1 <br /> Assessor Parcel # (s ) : 013-080-02 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: No <br /> 5. Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: No <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />