HomeMy WebLinkAboutDRC2010-00586 Non Const CUPState of California —The Resources Agen,,,
;a .0EPARTMENT OF FISH AND G) I T#
2010 ENVIRONMENTAL FILING FEE CASH RECEIPT 400796
STATECLEARING HOUSE #(Ifappficable)
SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY
N a FA F, mm
t1mvirzt, I I Ii I_rz ", _)0
-TIC/\J 0 V Pr\-& Z_L)
PQ ON 9wllul
PROJECTAPPLICANTNAMIE, I,R ONENUMBER
'T
i
11jAA 171- QAW,�t ODOA WN bA 60 L(� j)-,�
V.0, 1_17TX 'fll) I
I
PROJECT APPLICANT (Check appropriate box):
J Local Public Agency L] School District
L] Other Special District L] State Agency
Private Entity
CHECK APPLICABLE FEES:
L] Environmental Impact Report (EIR)
$2,792.25
$
Ll Mitigated/Negative Declaration (ND)(MND)
$2,010.25
$
L3 Application Fee Water Diversion (State Water Resources Control Board Only) . $850.00
$
Projects Subject to Certified Regulatory Programs (CRP)
$949.50
$
County Administrative Fee
$50.00
$ eli). N)
Project that is exempt from fees
21 Notice of Exemption
L] DFG No Effect Determination (Form Attached)
L] Other
$
PAYMENT METHOD:
6D
L] cash LJ Credit Check L] Other_
TOTALRECEIVED
$
SIGNATURE
X /Jw,�L� I
TITLE
ID(
WHITE -PROJECT APPLICANT YELLOW - DFG/ASB
PINK-LEADAGENCY GOLDEN ROD - COUNfYCLERK FG 753.5 a (Rev. 11/09)