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California Department of Fish and Wildlife <br />No Effect Determination Request Form <br />To: DEPARTMENT OF FISH AND WILDLIFE <br />South Coast Regional Office <br />3883 Ruffin Road <br />San Diego, CA 92123 <br />Information: (858) 4674201 <br />FAX: (858) 467-4299 <br />Email: AskR5@wildlife.ca.gov <br />http://www.wildlife.ca.gov <br />Environmental Review and Permitting <br />1416 Ninth Street <br />Sacramento, California 95814 <br />Information: (916) 6534875 <br />Date Submitted: <br />CEQA Lead Agency: <br />Lead Agency Contact Phone Number: <br />Lead Agency Address: <br />SCH Number or County Filing Number <br />and local agency project/case number: <br />CEQA Document Type (the type of <br />document prepared for your project by the <br />CEQA Lead Agency): <br />Applicant Name and Contact Phone <br />Number (if applicable): <br />Applicant Address (if applicable): <br />Project Title: <br />Project Location (include the street <br />address, lat/long, range/township/section, <br />or other description that clearly indicates <br />the location of the project site. Include an <br />aerial or topographic map of the project <br />site): <br />Project Description (include details such as <br />new construction [with square footage], <br />demolition of existing buildings, adaptive <br />reuse of existing buildings, zoning <br />amendments, general plan amendments, <br />conditional use for sale of alcoholic <br />beverages, etc.) Use additional sheets if <br />necessary: <br />REQUEST FOR FEE EXEMPTION\LA/Orange/San 1 FORM "L" <br />Diego/Santa Barbara and Ventura counties (Region 5) <br />75D-215 <br />