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L. Fee Deferral Schedule <br /> if the project's on-site air pollution reciuctiorts(mitigation.measure) insufficiently reouced air podution as outlined in Rule 95 10,an <br /> off-site fee is assessed based on the excess air pollution. The money collected ftm this fee will be used by the DLstrict to reduce air <br /> pollution emissions�off­sitC on behalf ofthe project <br /> -A-n Applicant may request a deferral of al I or part of the'off-site' fees up to,but not to exceed,the start date of construction. The start <br /> of construction is any of the follo-,vring,whicheew�r occcurs first: start of grading.start of demolition,or any other site development <br /> activities not mentioned above. <br /> f request a Fee Deferral Schedule,and have enclosed the Fee Deferral Schedule Application. <br /> v% a % <br /> M. Change of Project Developer <br /> The Applicant nsumes all responsibility for ISR compliance for this project. If the project developer changes,the Applicant must <br /> noinify the Buyer,and both Buyer and Applicant must file a'Change of Project Developer' form with the District. If there is a change <br /> of project developer,and a'Change of Project Developer' 'form is-not filed with the DistricL the ApplicarrL will remain liable for ISR <br /> compliance. <br /> N. Attachments <br /> Required. If applicable: <br /> Yj Tract Map or Project Des-Lip Map F ner from Applicani granting Aa t aunhorizarion <br /> Let en <br /> • Vicin� Map El Fee Deferral Schedule Application <br /> •AppLication Filing Fee El Monitorin!-& Reportin-Schedule <br /> SSA 1.00 for mixed use and non-residential projects OR Supporting documentation for selected Mifiggatrion Measures <br /> S562.00 for residential projects only <br /> 0. Certification Statement <br /> 1 certify thai I flave reviewed and completed the entire,applicaucin and hereby attest that the iDforrnafion relayed wititin is true and <br /> correct to the best of my knowledge. I cornmit to implementation of those on-site mitigation measures that I have selected above. I <br /> am responsible fbr notifying the District if I will be unable to implement these mitigation measures. If a committed Mitigation <br /> measure is not implemented,the project may be re-assessed for air quality impacts. <br /> (An authorized Acrent may sign the form in lieu of the Applicant if an authorization letter signed by the Applicant is provided). <br /> Name(printed): TJ VanderVeen Title: Project Engineer <br /> Signature: Date: 8.119P2O 19 <br /> Central Region Office: 1990 E.Gettysburg Ave.Fresno.CA 93726-C244 TEL(559)230�65000 FAX(559)230-6061 WEB <br /> Page 4 of 12 Residential/Non-Residential/Mixed-Use Application Form Revised June 28.2019 <br />