1701 W. Siva Ave
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Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-2188 . .
(714) 520-5741 FAX
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The gO-day period in which you may protest the fee described herein will begin on the date this fee is
paid. However, if the fee was imposed by the City or County as a condition of approval for your project, and you
have received the requisite notice, the gO-day protest period began at the time your project was approved.
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Receipt No: Elementary District: High School District:
c2.<f& '7 A-M1e',CI'\ C:,-+1/ 'S~.Jtot>)'1l\S-+r'lcr Anaheim Union High School District
Owner Information: fY\\~k~\ ---
Name: \\'0.<1 ~h"'.;,,
Address: \'10\ \A). 'S. ~ \/0- t>-v~.,
)
Phon!; Number: ( '7llj ) i'7{j) , )?5;J. '\
Applicant Information: SAme...
Name:
Phone Number: ( )
Property Information: ....
Address of Project: 1'70 \ L0. S;v'o-. 1\1/1<,) ~he~,""
Development Type: [ ] Residential - New [ ~eSjdential - Room Addition [ ] Commercial
Project Name: .-
Type: [ vr$ingle Family [ ] Multi-Family Condos/Apartments - # of units:
Commercial: ..-------- Residential:
Total Square Footage: [ ] Level'l [ ] Level 2 - ACSD Only [ ] Level 3- ACSD Only
Multiplied by Current Rate: Elem. $ ~ Total Square Footage: &/.;1..
~ $ -$ Multiplied by Current Rate: Elem. $ II;), =$itJ'is's.~~
=$ H.S. $ /. /d-. = ~S:.I.f<{
Equals Total Fee: $ r!l ".c)(f - $J6?O.~g
Fee Waiver:
fees waived: [ ] Yes [~ If yes, reason:
ACknowledgement:
The above representations as to square footage are true. Developer/Applicant agrees that if it is later determined that such
representations are not true, Certificate shall automati'i/'j:er(j'ate nd the appropriate City/County shall be notified.
Developer/Applicant Signature: J I '>lJ ~
Certification: .
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
1./ - LJ-O<:; 'v~ ~
Date Representative - Anaheim Union High School District
Actual Fees Paid: qtc /017
~-C:.:S D $ {o/? S, 4l( Check No.
Anaheim Union H.5. District $ lo'KS.t{I./ Check No. ~ 10 J(p
Distribution: City/County ~ Developer . Accountlno . Elementary District