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STATE OF CALIFORNIA -THE RESOURCES AGENCY <br />DEPARTMENT OF FISH AND GAME <br />EPIVIRONMENTAL FILIPIG FEE CASH RECEIPT <br />DFG ~sssa (s-o>> <br />Lead Agency: ~- <br />' /~ ~~ ~~~ ~Q-~. <br />County /State Agency of Filing: ~'7 ~-- <br />Project Title: <br />n <br />Ilcant Name: ~ ~ ~~-'~''~ `'~~ ~ <br />Project App ~ i + , ~ <br />r "~ / C.~ <br />j`, <br /> <br />n Docume-n No, ~l~ ~~~ G` <br />s' r „rnuno ivuiiu.~a <br /> <br />Project Applicant Address: ~ ~7 ~ <br />Project Applicant (check appropriate box): Local Public Agency ~ School District Private EnOtyer Special District ^ <br />State Agency ~ ^ <br />CHECK APPLICABLE FEES: $850.00 $ <br />( }Environmental Impact Report $x,250.00 $ <br />( )Negative Declaration <br />( )Application Fee Vuater Diversion (State Water Resources Control Board Only) $850.00 $ <br />$850.00 $ <br />( )Projects Subject to Certified Regulatory Programs Cp r; <br />$25.00 $ <br />(County Administrative Fee <br />T <br />( )Project that is exempt from fees f,~.~ ' ro <br />TOTAL RECEIVED $ ~ ~~ C ~' <br />Signature and title of person receiving payment: ~~! <br />WHITE-PROJECT APPLICANT YELLOW-DFG/FASB <br />AGENCY <br />GOLDENROD-STATE AGENCY OF FILING <br />