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r ' State of California - Department of Fish and Wildlife <br />2017 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFW 753.5a (Rev. 01/01/17) Previously DFG 753.5a 11 <br />r. <br />LEADAGENCY EMAIL <br />CITY OF SANTA ANA <br />THORNTON PARK SECURITY LIGHTING PROJECT <br />30.2017 462 <br />STATE CLEARINGHOUSE NUMBER (If applicable) <br />N/A <br />05/12/2017 <br />2017850000478 <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />MONICA SUTER,CITY OF SANTA ANA <br />1 (714) 647-5018 <br />PROJECT APPLICANT ADDRESS <br />CITY <br />STATE <br />ZIPCODE <br />20 CIVIC CENTER PLAZA <br />SANTA ANA <br />CA <br />92702 <br />PROJECT APPLICANT (Check appropriate box) <br />Q Local Public Agency E School District Other Special District ❑ State Agency ❑ Private Entity <br />CHECK APPLICABLE PEES: <br />❑ Environmental Impact Report(EIR) <br />[] MitigatedMegaiiva Declaration (MND)(ND) <br />❑ Certifled Regulatory Program document (CRP) <br />El Exempt from fee <br />0 Notice of Exemption (attach) <br />El CDFW No Effect Determination (attach) <br />❑ Fee previously paid (attach previously Issued cash receipt copy) <br />$3,078.25 $ 0.00 <br />$2,216.25 $ 0.00 <br />$1,046.50 $ 0.00 <br />Water Right Application or Petition Fee (State Water Resources Control Board only) $850.00 $ 0.00 <br />❑ County documentary handling fee $ 0.00 <br />❑ Other $ _ <br />PAYMENTMETHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ 0.00 <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />X17� , .1 r ®_ �, , .tre"c DULCE CUEVAS-DEPUTY <br />ORIGINAL- PROJECI APPLICANT COPY �CDFMASB COPY - LEAD AGENCY COPY -COUNTY CLERK DFW 763, 6a (Re, 201512' I6) <br />