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(a) Continued Applicant Authorized Agent Name
Authorized Agent Title and Affiliation
Agent Mailing Address
City County State Zip
Email FAX Phone (office)
Phone (cell)
(b) – (c) – (d) – (e)Other Permits/Licenses/Agreements/Plans
(attach copies to this notification as described in the instructions)
(b) & (c) Federal (Type and Permit/License Number)
(d) State (Type and Permit/License/Agreement Number)
(e) Other County, City, etc. (Type and Permit/License Number)
Other Required Documents or Plans (for example SWPPP)
(f) CEQA
CEQA Notice of Exemption (exemption name
and number)
Notice of Completion or Notice Availability
Attach draft or final CEQA Notice of Exemption, Notice of Completion or Notice of Availability.
Staff may request copes of all CEQA documents if needed to evaluate the project.
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Yucaipa Groundwater Sustainability Agency - March 14, 2018 - Page 105 of 226