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State of California • Depar meal of Fish and Wldilfe <br />2019 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFW 753,5a (Rev, 01/01/18) Previously DFG 753.5E <br />G <br />30-2019 0927 <br />ITATE CLEARIN( <br />N/A <br />LEADAGENCY EMAIL <br />CITY OF SANTA ANA 09/18/2019 <br />COUNTY/STATE AGENCY OF FILING DOCUMENT NUMBER <br />(lrannA 201985000953 <br />RESIDENTIAL ST REPAIR FY 16/10 HEININGER <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />P 0 E UMBER <br />CITY OF SANTA ANA <br />(714) 847-5018 <br />PROJECTAPPLICANTADDRESS <br />CITY <br />S7ATE <br />ZIP CODE <br />20 CIVIC CENTER PLAZA M-20 <br />SANTA ANA <br />ICA <br />92702 <br />PROJECT APPLICANT (Cheek appropdafa box) <br />[]1 Local Public Agency I] School District © Other Special Dlsirlci <br />( State Agency [] Private Entlly <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (Elk) <br />$3,27Ltl0 $ <br />0.00 <br />❑ MlllgafedlNegallve Declaration (MND)(ND) <br />$2,354.75 $ <br />0,00 <br />F1 CertiFled Regulatory Program document (CRP) <br />$1,112.00 $ <br />0.00 <br />EI Exempt from fee <br />E Notice of Exemption (attach) <br />❑ OCFW No Effect Daterminatlon (attach) <br />- <br />❑ Fee previously paid (attach preWously Issued cash receipt copy) <br />❑ Water Right Application or Petition Fee (SIRO Water Resources Control Board Only) $350.00 $ 0.00 <br />❑ County documentary handling fee $ 0,00 <br />❑ Other $ <br />PAYMENT METHOD: <br />❑ Cash EI Credit ❑ Chock 0 Other TOTAL RECEIVED $ 0.00 <br />ORIGINAL. PROJECT APPLICANT WPY•CDWASO COPY -LEAD AGENCY COPY, COUNTY CLERK DFW 1616a lR6V. 2e1MIS) <br />