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'IRONMENTAL DECLARATION <br />(CALIr.jixv4IA FISH AND GAME CODE SEC. i 11.4) <br />FOR W&Ihfd%� <br />NAME AND ADDRESS OF APPLICANT OR LEAD AGENCY: <br />City of San Leandro <br />Development Services Department <br />835 East 14th Street <br />San Leandr, CA 94577 <br />CLASSIFICATION OF ENVIRONMENTAL DOCUMENT: <br />1. NOTICE OF EXEMPTION/STATEMENT OF EXEMPTION <br />[X] A- STATUTORILY OR CATEGORICALLY EXEMPT <br />$25.00 (Twenty-five Dollars) - CLERK'S FEE <br />5 E P 0 9 1996 <br />PATRICK O'CONNE>_L: County Cleric <br />B Depuf}r <br />FILING NO. <br />CLERK'S <br />USE ONLY <br />PLU 117 <br />[ ] B - DE MINIMUS IMPACT - CERTIFICATE OF FEE EXEMPTION REQUIRED PLU 117 <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 (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 />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 <br />g Aa-forms\cega\fi I ing. cvr <br />