1114 N. Louise Dr.
~
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.
Owner Information:
Name:
Address:
Phone Number:
M~/;~'(1)~. A{2:>f~ ~ LA.
)
High School District:
Anaheim Union High School District
Receipt No:
d(";ij7)1
Elementary District:
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Applicant Information:
Name:
Phone Number: (
~
tAL d7~.
Property Information:
Address of Project:
Development Type: ] Residential - New
Project Na me:
Type: [')t1 Single Family
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.S. $
Q~ c&:L.. d-,;~
[)6 Residential - Room.Addition Commercial
Multi-Family Condos/Apartments - # of units:
Equais Total Fee:
$
=$
=$
-$
Residential:
[ ] Levell [ ] Level 2 - ACSO Ooly [ ] Level 3- ACSO Ooly
rl"1.-
Total Square Footage: /<7\ ....-
Multiplied by Current Rate: Elem. $ '/ / t2..-' $~d'"3
H.s. $ I I ::v - $ .Jo
Equals Total Fee: $ ~.':::z.."; -$ .
Fee Waiver:
Fees Waived:
] Yes
[fl No
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 automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
c
Certification:
This certifies that the above named Dev
Sections 53080 and 65995.
6/?ios-
Date f r
ActUImD
Anaheim Union" M.s. :District
. perl Applicant has paid school facility fees in compliance with Government Code
11d~
$
$
f:~ ~ ~
Check No.
Check No.
/11 '1
1/1 <{
Distribution: City/County - Developer - Accounting - Elementary District