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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 �6W#RR- AGENT OF OWNER <br /> Name 1„ 'R qT» 6 ANG /a DNAf? oN <br /> Address Q64? -7E S . p 1qav ;A p6A ,� <br /> City TR a C �i <br /> State/Zip (_o4 - q5 ,3-7 ,1 <br /> Phone R 30 - 0 :-� a A <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> [� Zone Reclassification, [Z Minor Subdivision, Q Site Approval, <br /> QZone variance, Q Other : <br /> 2 . Project location: $ , CmRrVE2hr_ V� �/ LAl HoPmP ' �?�i 7 LAT/f 2oi� <br /> Describe the project; i .e. , request being made and nature of dse . <br /> Identify specific project components : _7 ►lint /1N l-x� < ;I .,Ir <br /> Quj-- "'S ) Zf7 Byp )_ C_v LST //Vin ?L\IA '5/1i6T1-' E rA1n114 Ld i <br /> 3 . Total acreage of project: o Ly r S # of existing parcels :—C N,C- <br /> Assessor Parcel # (s ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: N //4 <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : /VIA <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />