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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 �eW-N£R AGENT OF OWNER <br /> Name � , 'R q �ii <br /> Address_ 4 7 Q S . j?, /a ev ;A VMA (- <br /> City TT1 A la \.-i <br /> State/Zip (_v4 - q5 ,3-2g <br /> Phone R 30 - 9 ,-� a A <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 /> Zone variance, Q Other: <br /> 2 . Project location: S, C . C�RNL^2 nr_ A V(1 A/ & LATH p,6P ' 'P'J A> LAj/1'0 <br /> Describe the project; i .e . , request being made and nature of dse . <br /> Identify specific project components : -,) i t)jnr /4 (V <br /> Q U/=k ,S)� !)y P /_- C Y L,o Z //L/—1 -r) 7 L\!A A m l 14 L D 75, <br /> 3 . Total acreage of project: D # of existing parcels : N/= <br /> Assessor Parcel Us ) : <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 : NIA <br /> PERMIT AGENCY <br /> Minor Subdivision - 7 - ( 6/86 ) <br />