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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 /> Jl9RT4GIL <br /> PERSON COMPLETING FORM _PROPERTY eW-NER AGENT OF OWNER <br /> Name L . iR/912 6 61 A n/G A 1 /2 /3-Elq a1 <br /> Address * A 13 -7 R ,T _ (J� An,:A PPA 1> <br /> City ?'R n C A — `j cam_-a�_;-_4 <br /> State/Zip <br /> Phone ?, <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application: Q use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, 0 Minor Subdivision, 0 Site Approval, <br /> QZone Variance, Q Other: <br /> 2 . Project location: S E . CoR,yG2 of AVnn! ?r,,a1-) 9 � nn/U111r, 2e)A1� ,1_4 ear <br /> Describe the project; i .e . , request being made and nature of use . <br /> Identify specific project components : T_)) V 1f)r A n/ L- x 1.S 7i /V G 611 R6)2G, <br /> D(2 ,21_ rY ?Wt�) �S/Almy(--A M ►,Ly <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: MIA <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 />