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State of California - Department of Fish and Wildlife <br />2024 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5n (REV. 01/01123) Previously DFG 753.5e <br />t�lnt 5tartaver "Save <br />RECEIPT NUMBER: <br />30 -- 12/19/2024 -- 1085 <br />STATE CLEARINGHOUSE NUMBER (if applicable) <br />SEE IKSTRUCTIONS ON REVERSE. TYPE ORPRINTCLEARLY. <br />LEADAGENCY LEADAGENCY EMAIL DATE <br />CITY OF SANTA ANA 12/19/2024 <br />COUNTYISTATEAGENCY OF FILING DOCUMENT NUMBER <br />Orange 202485001102 <br />PROJECT TITLE <br />CIVIC CENTER REHABILITATION SHELTON TO FLOWER <br />PROJECT APP LICANT NAME PROJECT APPLICANT EMAIL <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />PROJECT APPLICANT ADDRESS CITY <br />20 CIVIC CENTER PLAZA M-36 SANTA ANA <br />PROJECT APPLICANT (Check appropriate box) <br />© Local Public Agency ❑ School District [ Other Special District <br />CHECK APPLICABLE FEES: <br />❑ Environmental impact Report (EIR) <br />❑ MitigatedlNegaUve Declaration (MND)(ND) <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />El Exempt from fee <br />21 Notice of Exemption (attach) <br />❑ CDFW No Effect Determination (attach) <br />❑ Fee previously paid (attach previously issued cash receipt copy) <br />PHONE NUMBER <br />(714 ) 647-5665 <br />STATE ZIP CODE <br />CA 92702 <br />❑ State Agency Q Private Entity <br />$4,051.25 $ 0.00 <br />$2,916.76 $ O.OD <br />$1,377.25 $ 0.00 <br />❑ Water Right Appllcation or Petltion Fee (State Water Resources Control Board only) $850.00 $ 0.00 <br />❑ County documentary handling fee $ <br />❑ Other $ <br />PAYMENT METHOD. <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ 0.00 <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />X %/�,MELISSA GOMEZ, DEPUTY <br />ORIGINAL -PROJECT APPLICANT COPY -COMABB COPY-LEADAGENCY COPY -COUNTY CLERK DPWM.5atROV,01Io11=3) <br />