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State of California - Department of Fish and Wildlife <br />2023 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV. 01/01/23) Previously DFG 753.5a <br />Save <br />RECEIPT NUMBER: <br />30 -- 12/20/2023 — 1119 <br />ATE CLEARINGHOUSE NUMBER {lfappAcable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />LEADAGENCY LEADAGENCY EMAIL DATE <br />CITY OF SANTA ANA PUBLIC WORKS AGENCY 12/20/2023 <br />COUNTYISTATE AGENCY OF FILING DOCUMENT NUMBER <br />Orange ram; 202385001140 <br />PROJECT TITLE <br />SANTIAGO MAIN ST ENTRANCE <br />PROJECTAPPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA PUBLIC WORKS AGENCY <br />t } <br />PROJECTAPPLICANTADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />24 CIVIC CENTER PLAZA M-36 <br />SANTA ANA <br />CA <br />92702 <br />PROJECT APPLICANT (Check appropriate box) <br />Q Local Public Agency School District ❑ Other Special District <br />❑ State Agency <br />❑ Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$r3,839.25 <br />$ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) <br />$2,764.00 <br />$ <br />0.D0 <br />❑ Cortifled Regulatory Program (CRP) document - payment due directly to CDFW <br />$1,306.26 <br />$ <br />0.00 <br />El Exempt from fee <br />0 Notice of Exemption (attach) <br />❑ CDFW No Effect Determination (attach) <br />❑ Fee previously paid (attach previously Issued cash receipt copy) <br />❑ Water Right Application or Petition Fee (State Water Resources Control Board only) <br />$850.00 <br />$ <br />0.00 <br />❑ County documentary handling fee <br />$ <br />❑ Other <br />$ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL <br />RECEIVED <br />$ <br />0.00 <br />SIGNAXTREI AGENCY OF FILING PRINTED NAME AND TITLE <br />DEPUTY CLERK, VANESSA DEVIA MARQUEZ <br />ORIGINAL -PROJECT APPLICANT COPY -CDFWIASB COPY-LEADAGENCY COPY -COUNTY CLERK DFW753.5a(Rev.OVOV2023) <br />