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*ENVIRONMENTAL DECLARATION <br />(CALIFORNIA FISH AND GAME CODE SEC. 711.4) <br /> FOR COL~ <br />T~ ~U~lT~ <br /> ~ <br />NAME AND ADDRESS OF APPLICANT OR LEAD AGENCY; a <br />FILING REQUESTED BY: ~~`~'' ~ °~ <br />City of San Leandro <br />Conlmuiuty Development Department ~~YRICN:O'Cbi~INE9~., ~~- Cl~c <br />835 East 14~' Street ~ <br />C~_ <br />~~`~~~"~~ P~ <br />San Leandro, CA 94577 ~ <br />VVIIEN FILED RETURN T®. ° <br />FILING NOS ~~` <br />Cite of San Leandro <br />City Clerk a <br />83S East .14th Street <br />San Leandro CA 94577: ~ u <br />u <br />` CLERK'S <br />CLASSIFICATION OF ENVIRONMENTAL DOCUMENT: ~ USE ONLY <br />1, NOT E OF~EXEMPTI{JN/STATEMENT OF EXEMPTION PLU 117 <br />A-...STATUTORILY OR CATEGORICALLY EXEMPT <br />$25,00 (Twenty-five Dollars) -CLERK'S FEE <br />[ ] B - DE MIN7MUS IMPACT (GOVERNMENT 3 27383) PLU 117 <br />CERTIFICATE OF FEE EXEMPTION REQUIRED <br />$25.00 (Twenty-five Dollars) -CLERK'S FEE <br />2. NOTICE OF DETERMINATION -FEE REQUIRED PLU 116 <br />[ ] A -NEGATIVE DECLARATION <br />$1,250.00 (Twelve Hundred Fifty Dollars) -STATE FILING FEE <br />$25.00 (Twenty-five Dollars) -CLERK'S FEE <br />[ ] B -ENVIRONMENTAL IMPACT REPORT ~ PLU 1 I5 <br />$850.00 (Eight Hundred Fifty Dollars) -STATE FILING FEE <br />$25.00 (Twenty-five Dollars) -CLERKS FEE <br />3. [ ] OTHER (Specify) PLU 117 <br />$25.00 (Twenty-five Dollars) -CLERK'S FEE <br />*THIS FORM MUST BE COMPLETED AND SUBMITTED WITH ALL ENVIRONMENTAL DOCUMENTS <br />FII,ED WITH THE ALAMEDA COUNTY CLERK'S OFFICE. <br />FOUR COPIES OF ALL NECESSARY DOCUMENTATION ARE REQUIRED FOR FILING PURPOSES. <br />APPLICABLE FEES MUST BE PAID AT THE TIME OF FILING AN E1~~TIRONMENTAL DOCUMEI~TT <br />WITH THE ALAMEDA COUNTY CLERK'S OFFICE. <br />MAKE CHECK PAYABLE TO: AL~~VIEDA COUNTY CLERK_ <br />Rev. 1/15/91-1056C g:~-fon»~~~ega~i~n=.w~ <br />