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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 /> pig 7r✓E,2 <br /> PERSON COMPLETING FORM i/ PROPERTYnOWNER AGENT OF OWNER <br /> Name L. . R n 3'A G A rYC/;-D HA RArJ <br /> Address _ 9, Ar17/a RdA )p <br /> City ; SCA . g5376 <br /> State/Zip <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q use Permit, Q Major Subdivision, <br /> 0 Zone Reclassification, EJ Minor Subdivision, E] Site Approval, <br /> EJ Zone variance, [] Other: <br /> 2 . Project location: CoRNGR oT lqi/o w gg-p , rog r 1-9T ?ay <br /> Describe the project; i .e . , request being made and nature of 'use. <br /> Identify specific project components : (70M13inrE 6x IS7j 6. T W 6 <br /> DUPLEX Lo i.5 ANb /3 S /1f61,E FAwl, L-42: 41Yi) iIDrVILE THEM <br /> INTO ErDUR 51A1 5LE FAM) U PC- SMF //�7/At— 1- e0iS . <br /> 3 . Total acreage of project: p . 7 ,�- # of existing parcels : <br /> Assessor Parcel # (s ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date:_ A/ /q <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project : <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />