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ENVIRONMENTAL INFORMATION FORM <br />(For private projects, this form must be completed by private project applicant to assist staff in completing Initial Study) <br />Date Filed: <br />GENERAL INFORMATION <br />1. <br />Developer or project sponsor <br />Name: <br />Address: <br />2. <br />Project Location — Identify street <br />address and cross streets or attach <br />a map showing project site <br />(preferably a USGS 15' or 7 I/2' <br />topographical map identified by <br />quadrangle name): <br />3. <br />Assessor's Block and Lot Number <br />4. <br />Person to be contacted regarding <br />Name: <br />this project <br />Address: <br />Telephone: <br />5. <br />Permit Application Number for <br />project <br />6. <br />Existing Zoning District <br />7. <br />Proposed use of site (project for <br />which this form is filed) <br />List and describe any other related permits and other public approvals required for this project, including those required <br />by city, regional, state and federal agencies: <br />8. Site size: <br />9. Square footage: <br />10. Number of floors of construction: <br />11. Amount of off-street parking <br />provided: <br />12. Attach plans: <br />13. Proposed scheduling: <br />14. Associated projects: <br />15. Anticipated incremental <br />development: <br />Environmental Information Form 1 FORM "I" <br />75D-196 <br />