Laserfiche WebLink
State of California - Department of Fish and Wildlife <br />2024 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV. 01101123) Previously DFG 753.5a <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />LEAD AG E NCY L <br />CITY OF SANTA ANA <br />COUNTY/STATE AGENCY OF FILING <br />Orange IT <br />PROJECT TITLE <br />BRISTOL-TOLLIVER STREET URBAN GREENING <br />PROJECT APPLICANT NAME <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />PROJECT APPLICANT ADDRESS <br />20 CIVIC CENTER PLAZA M-36 <br />PROJECT APPLICANT (Check appropriate box) <br />© Local Public Agency ❑ School District ❑ <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />❑ MitigatedlNegative Declaration (MND)(ND) <br />❑ Certified Regulatory Program (CRP) document - payment due dir <br />R Exempt from fee <br />I] Notice of Exemption (attach) <br />❑ CDFW No Effect Determination (attach) <br />❑ Fee previously paid (attach previously issued cash receipt copy) <br />g F?rint Save <br />RECEIPT NUMBER: <br />30 — 12/12/2024 — 1069 <br />STATE CLEARINGHOUSE NUMBER (If applicable) <br />EADAGENCY EMAIL <br />DATE <br />12/12/2024 <br />DOCUMENTNUMBER <br />202485001076 <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />(714 ) 647-5647 <br />CITY <br />STATE <br />ZIP CODE <br />SANTA ANA <br />CA <br />92702 <br />Other Special District <br />❑ State Agency [] Private Entity <br />$4,051.25 $ 0.00 <br />$2,916.75 $ 0.00 <br />ecily to CDFW <br />$1,377.25 $ 0.00 <br />❑ Water Right Application or Petition Fee (State Water Resources Control Board only) $850.00 $ <br />❑ County documentary handling fee $ <br />® Other $ <br />PAYM ENT M ETHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />X�h7'yl/i-P�� MELISSA GOMEZ, DEPUTY <br />1 11 <br />99 <br />ORIGINAL-PROJECTItLyA OLt11Cll COP 9 - 65 �/� Q/2025'5a(Ray.01f0112023) <br />