Attachment B
Statutory Exemptions. State code number:
_______________________________________________
Print Form
Notice of Exemption Appendix E
From: (Public Agency): ____________________________
To: Office of Planning and Research
P.O. Box 3044, Room 113 _______________________________________________Sacramento, CA 95812-3044 County Clerk
(Address)
___________________________
___________________________
County of: __________________
Project Title: ____________________________________________________________________________ Project Applicant: ________________________________________________________________________ Project Location - Specific:
Project Location - City: ______________________ Project Location - County:
Description of Nature, Purpose and Beneficiaries of Project:
_____________________
Name of Public Agency Approving Project: _____________________________________________________ Name of Person or Agency Carrying Out Proj ect: ________________________________________________ Exempt Status: (check one):
Ministerial (Sec. 21080(b)(1); 15268);
Declared Emergency (Sec. 21080(b)(3); 15269(a));
Emergency Project (Sec. 21080(b)(4); 15269(b)(c));
Reasons why project is exempt:
Lead Agency
Contact Person: ____________________________
Area Code/Telephone/Extension: _______________
If filed by applicant:
1. Attach certified document of exemption finding.
2. Has a Notice of Exemption been filed by the public agency approving the project? Yes No
Signature: ____________________________ Date:
Signed by Lead Agency
Signed by Applicant
Authority cited: Sections 21083 and 21110, Public Resources Code. Date Received for filing at OPR:
Reference: Sections 21108, 21152, and 21152.1, Public Resources Code. _______________
Categorical Exemption. State type and section number: ____________________________________ ______________________________________________
______________ Title: _______________________
Revised 2011
City of Victorville
14343 Civic Drive
Victorville, CA 92392
San Bernardino
385 North Arrowhead Ave, Second Floor
San Bernardino, CA 92415-0130
Mojave Drive and Village Drive Pipeline Repair Project
Victorville Water District
Northwest corner of Mojave Drive and Village Drive, specifically at 15322 Village Drive Victorville
San Bernardino
Abandon-in-place existing leaking 10" water main situated beneath the Gas Station's drive aisle concrete slab and replace it with a new 10" pipe installed under the sidewalk within the public Right-Of-Way.
Victorville Water District
City of Victorville
x
15280k
Replacement of existing water main with no expansion of use Fredy A. Bonilla, City Engineer
760-955-5170
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