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State of California - Department of Fish and Wildlife <br />2020 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFW 753.5a (Rev. 01/01/18) Previously DFG 753.5a <br />r. <br />ECIIPT NUMBER: <br />30-2020 0953 <br />STATE CLEARINGHOUSE NUMBER (If applicable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />NIA <br />LEAD AGENCY <br />LEADAGENCY EMAIL <br />DATE <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />11/25/2020 <br />COUNTY/STATE AGENCY OF FILING <br />DOCUMENT NUMBER <br />Orange <br />202085000958 <br />PROJECT TITLE <br />MCFADDEN AVE PROTECTED BIKE LANE <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />(714) 647-5632 <br />PROJECT APPLICANT ADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />20 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 <br />Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) $3,343.25 <br />$ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) $2,406.75 <br />$ <br />0.00 <br />❑ Certified Regulatory Program document (CRP) $1,136.50 <br />$ <br />0.00 <br />0 Exempt from fee <br />E 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 />0.00 <br />❑ County documentary handling fee <br />$ <br />0.00 <br />❑ Other <br />$ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check 0 Other TOTAL RECEIVED $ <br />0.00 <br />SIGNATURE <br />AGENCY OF FILLING PRINTED NAME <br />AND TITLE <br />X <br />SARAHY JURADO, DEPUTY <br />CLERK <br />ORIGINAL-PROJFCTAPPLICANT COPY-CDFWIASB COPY - LEAD AGENCY COPY -COUNTY CLERK DFW753,5a(Rev.20151215) <br />