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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 /> 1/9RT,,�C2 <br /> PERSON COMPLETING FORM ��PROPERTY 6W-NER AGENT OF OWNER <br /> Name ,- . i�/ r A n/G A i-)J4 A-l2A AJ <br /> Address 3� 63 -? R i . 2 A.,.1 A Q P)A )-� <br /> City -F A c� (-, A _ 6 <br /> State/Zip <br /> Phone R 3 3 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Z Minor Subdivision, Q Site Approval, <br /> Q Zone variance, Q Other : <br /> 2 . Project location: S. E . Cop NG2 of AVn,(\l ?r3an 9 (—) (') f-2U U I (- 2y, 0 L9;ne6� <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : D) V I flr A n/ L- x l.S 71 iV G CLSR512,> <br /> 1)()pi_f=V n\) 7`6 7wo sj.,jaL ,5 rA mj,zv � E'SI DCNTIA�_ t�r5. <br /> 3 . Total acreage of project: O . # of existing parcels : ©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 �A <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: AVIA <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />