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r t <br />ENVIRONMENTAL DECLARATIOI~ <br />(CALIFORNIA FISH AND GAME CODE SEC. 711.4) ~ ~ ~ ~ <br />CITY'CF SAN tE'A.NR co~~~~~,~~ <br />NAME AND ADDRESS OF APPLICANT OR LEAD AGENCY: <br />FILING REQUESTED BY: <br />City of San Leandro <br />Development Services Department <br />835 East 14th Street <br />San Leandro, CA 94577 <br />MAR 0 4 200 ,SA~~ ~ ~ 2~~2 <br />CITY CLERK'S OFFICE sA~ ~ t~'CO~~~.~ ~c'un~r~ C <br />WHEN FILED RETURN TO: CITY QF S~ LEA~~RO FII.,ING NO. (~ ~ ~' C? ~ ~ ~- <br />City ofSan Leandro <br />City Clerk MAR 0 4 20Qz <br />835 East 14th Street <br />San Leandro, CA 94577 : <br />CITY CLERK'S OFFICE <br />CLERK'S <br />CLASSIFICATION OF ENVIRONMENTAL DOCUMENT: USE ONLY <br />1. NOTICE OF EXEMPTION/STATEMENT OF EXEMPTION PLU 117 <br />~,~TATUTORILY OR CATEGORICALLY EXEMPT <br />$25.00 (Twenty-five Dollars) -CLERK'S FEE <br />[ ] B - DE MINIMUS IlVIPACT (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 115 <br />$850.00 (Eibht Hundred Fifty Dollars) -STATE FR;IlVG 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 />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:~a-forms\cega\filing.cvr <br />