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Print Form
Notice of Determination Appendix D
To: From:
Office of Planning and Research Public Agency: ___________________________
Address: ________________________________U.S. Mail: Street Address: _______________________________________P.O. Box 3044 1400 Tenth St., Rm 113 Contact: _________________________________Sacramento, CA 95812-3044 Sacramento, CA 95814 Phone: __________________________________
County Clerk Lead Agency (if different from above): County of: _________________________________
Address: __________________________________ Address: ________________________________
Contact: _________________________________
Phone: __________________________________
SUBJECT: Filing of Notice of Determination in compliance with Section 21108 or 21152 of the Public
Resources Code.
State Clearinghouse Number (if submitted to State Clearinghouse):______________________________
Project Title: _________________________________________________________________________
Project Applicant: _____________________________________________________________________
Project Location (include county):_________________________________________________________
Project Description:
This is to advise that the ____________________________________________ has approved the above
( Lead Agency or Responsible Agency)
described project on _______________ and has made the following determinations regarding the above
(date)
described project.
1. The project [ will will not] have a significant effect on the environment.
2. An Environmental Impact Report was prepared for this project pursuant to the provisions of CEQA.
A Negative Declaration was prepared for this project pursuant to the provisions of CEQA.
3. Mitigation measures [ were were not] made a condition of the approval of the project.
4. A mitigation reporting or monitoring plan [ was was not] adopted for this project.
5. A statement of Overriding Considerations [ was was not] adopted for this project.
6. Findings [ were were not] made pursuant to the provisions of CEQA.
This is to certify that the final EIR with comments and responses and record of project approval, or the
negative Declaration, is available to the General Public at:
Signature (Public Agency): _____________________________ Title: ____________________________
Date: _______________________________ Date Received for filing at OPR: ____________________
Authority cited: Sections 21083, Public Resources Code.
Reference Section 21000-21174, Public Resources Code. Revised 2011