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State of Cellfomis - Department of Fish and Wildlife <br />2019 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />4' DFW 753,5a (Rev. a1101118) Previously DFG 753.5a r <br />u <br />fi <br />30-2019 1138 <br />STATE CLEARINGHOUSE NUMBER (ff apOcable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />2018021031 <br />LEADAGENCY <br />LEADAGENCY EMAIL <br />DATE <br />CITY OF SANTA ANA <br />11/2012019 <br />COUNTYISTATE AGENCY OF FILING <br />DOCUMENT NUMBER <br />Orange <br />201985001169 <br />PROJECTTITLE <br />2525 N. MAIN STREET MULTI -FAMILY RESIDENTIAL PROJECT <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />AC 2525 MAIN LLC. <br />(714)667-2740 <br />PROJECT APPLICANT ADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />2525 MAIN STREET <br />SANTA ANA <br />CA <br />92705 <br />PROJECT APPLICANT (Check appropriate box) <br />I] Local Puhllc Agency 0 School District Other Special District <br />State Agency [✓7 Private Entity <br />CHECK APPLICABLE FEES <br />© Environmental Impact Report (EIR) <br />$3,271.00 <br />$ <br />3,271,00 <br />❑ MitlgatedlNegative Declaration (MND)(NO) <br />$2.354.75 <br />$ <br />().()0 <br />❑ Certified Regulatory Program document (CRP) <br />$1,112.00 <br />$ <br />0.00 <br />❑ Exampt from fee <br />❑ Notice of Exemption (attach) <br />❑ CDFW No Effeol Delerminallan (a0ach) <br />❑ Fee previously paid (attach previously Issued cash receipt copy) <br />❑ Water Right Application or PetlBun Fee (State Water Resources Control Board only) $850.00 $ 0.00 <br />[j] County documemary handling fee $ 50.00 <br />❑ Other $ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ 3,321 .00 <br />SIGMAIURE GENCY OF FILING PRIN I tU NAMI. ANU I I I Lk <br />-- DIANNA VELASQUEZ, DEPUTY CLERK <br />ORIOINAL. PROJECT APPLICANT COPY. CDFYWA5B COPY -LEAS AGENCY COPY- COUE7IY CLERK DPW 751.5a(Rev, 2051215) <br />