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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 /> /�ARir✓E,2 <br /> PERSON COMPLETING FORM i/ PROPERTY,.,OWNER AGENT OF OWNER <br /> Name L . R Fl J'A G A (v �D NA RQ rd <br /> Address 069 -? g -:7 pp N;/q ROA tp <br /> City <br /> State/Zip <br /> Phone <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, 0 Minor Subdivision, Q Site Approval, <br /> Zone variance, Q Other: <br /> 2 . Project location: C-DRNC-R 0I-' A iy Rd/9� c5'("NR/ STG 9i/�1?o� <br /> Describe the project; i .e . , request being made and nature of ,use . <br /> Identify specific project components : (70m13/nrE Ex /sTjN 6 TW <br /> .DUPLEX Ln7.5 ANS A CJ/ /.� r-19M11 L-67--4NID IDIIIIbc- THEM <br /> INTO f= r9 ) R 5 111 L E A 6Y11 1 v 6� C S !�F X117/A L r�i S <br /> 3 . Total acreage of project: 0 . 7 ,,�_ #) of existing parcels : <br /> Assessor Parcel Us ) : <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: ti /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 />