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*ENVIRONMENTAL DECLARATION <br />~• <br />(CALIFORNIA FISH AND GAME CODE SEC. 711.4) <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 />WHEN FILED RETURN TO: <br />City of San Leandro <br />City Clerk <br />835 East 14th Street <br />San Leandro, CA 94577 <br />CLASSIFICATION OF ENVIRONMENTAL DOCUMENT: <br />1. N ICE OF EXEMPTION/STATEMENT OF EXEMPTION <br />A- STATUTORILY OR CATEGORICALLY EXEMPT <br />$25.00 (Twenty-five Dollars) -CLERK'S FEE <br />' , [ ] B - DE MINIMUS IMPACT (GOVERNMENT 3 27383) <br />CERTIFICATE OF FEE EXEMPTION REQUIRED <br />,r $25.00 (Twenty-five Dollars) -CLERK'S FEE <br />PLU 117 <br />PLU 117 <br />2. NOTICE OF DETERMINATION -FEE REQUIItED 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 - ENVRONMENTAL 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 ENVRONMENTAL 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 />FOR COURT USE ONLY <br />~~L.~~ <br />Au~~n~oa counter <br />oEC ~ 1 200 <br />. PATRf CK Q'CQNNF..L~,,; County Ctetk <br />sy~' t~uty <br />~1~~-0 <br />CLERK'S <br />USE ONLY <br />Rev. 1/15/91-1056C g:~-corms~oega~filing.cvr <br />