1428 W. Park Ave.
~
Anaheim Union High. Schaal Oisfr'ict
501 Crescent Way, P.O. Box 3520, Anaheim; CA 92803-3520
(714) 999-2188
(714) 520.5741 FAX
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CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The 90-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 90-day protest period began at the time your project was approved.
Receipt No:
023~3
Elementary District:
A-nO-he;~ C,,+ ~} J\'drler
High School District:
Anaheim Union High School District
Owner Information:
Name:
Address:
Phone Nurnb-er:-
~r fYx:>.- PiW(\ <>
14.Q..'i? LlL .p",~K A.lle,
0; 9 I-)?y o'l
) IJr.ah e, YY1
'71'f
Applicant Information:
Name:
Phone Number: (
'IrlY'>Oo.
)
P'20.J\O
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
Ilf~8 W, Po...d~. Ave .) liMlte,,,,-
] ReSidential - New [ ....o'ReSidential - Room Addition
] Commercial
[ v(5ingle Family
] Multi-Family Condos/Apartments - # of units:
Commercial:
Total Square Footage: ~..
Multiplied by Current Rate: Ele~ = $
.------H."s. $ = $
-----
Equals Total .e,,: $ = $
Residential:
[ ] Level 1 [ ] Level 2 - ACSD Only [ ] Level 3- ACSO Only
Total Square Footage: In 1D
Multiplied by Current Rate: Elem. $ r I.;J. - $ II h </. 'i((l
H.S. $ ~ = $iI{p(/.~O
Equais Total Fee: $ dl..,;[ <; = $J(32 "I.("c
Fee Waiver:
Fees Waived:
Yes
[ vr;;o
If yes, reason:
Acknowledgement:
The above representations as to s/q a fa age} are true. Devel~perl pplicant agrees that if it is later determined that such
, .
representations are not true, Cettifica e e and the appropriate City/County shall be notified.
aid school facility fees in compliance with Government Code
Developer/Applicant Signature:
Certification:
This certifies that the above named Developer/ Applican
Sections 53080 and 65995.
j d.1D)()1
I
Date
Actua I Fees Paid:
-A~~D
$
$
IIf~lUr6
If iRq.. ~O
Check No.
Check No.
.20'17
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. Anaheim Union H.5. District
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