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ENVIRONMENTAL DECLARATIOI~ <br />(CALIFORNIA FISH AND GAME CODE SEC. 711.4) ~, ~ <br />FOR COURTAUSE ~NL~OUNTY <br />NAME AND ADDRESS OF APPLICANT OR LEAD AGENCY: ~ ~ ~ ~ ~ ~Q~~ <br />FILING REQUESTED BY: <br />City of San Leandro PATRICK Q~CQNN~, Courtly Clerk <br />Development Services Department <br />835 East 14th Street <br />San Leandro, CA 94577 ; <br />WHEN FILED RETURN TO: FILING NO. ~~~ ~ ~' ~ <br />City of San Leandro <br />City Clerk <br />835 East 14th Street <br />San Leandro, CA 94577 <br /> <br />CLERK'S <br />CLASSIFICATION OF ENVIRONMENTAL DOCuivIENT: USE ONLY <br />1. N CE OF EXEMPTION/STATEMENT OF EXEMPTION PLU 117 <br />] A- STATUTORILY OR CATEGORICALLY EXEMPT <br />$25.00 (Twenty-five Dollars) -CLERK'S FEE <br />[ ] B - DE 1VIIl~IIlVIUS 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 - NEGATNE 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 115 <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 />FILED WITH THE ALAMEDA COUNTY CLERK'S OFFICE. <br />FOUR COPIES OF ALL NECESSARY DOCUMENTATION ARE REQUIRED FOR FILING PURPOSES. <br />~` <br />APPLICABLE FEES MUST BE PAID AT THE TIME OF FILING AN ENVIRONMENTAL DOCUMENT <br />WITH THE ALAMEDA COUNTY CLERK'S OFFICE. <br />MAKE CHECK PAYABLE TO: ALAMEDA COUNTY CLERK <br />Rev. 1/15/91-1056C g:~-eo,as~~ega~fil~g.~,~ <br />