1139 W. South St.
~
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.
ElementaJj~ D
High School District:
Anaheim Union High School District
Owner Information:
Name:
Address:
Phone Number:
0~J.
)
Applicant Information:
Name:
Phone Number: (
Dh-u.. .:G.s
~
Property Information:
Address of Project:
Development Type: ] Residential - New
Project Name:
Type: [YJ Single Family
COmmercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.S. $
~~~
,"\
V Residential - Room. Addition
Commercial
MUlti-Family Condos/Apartments - # of units:
Equals Total Fee: $
-$
=$
= $
Residential:
[ ] Level 1 [ ] Level 2 - ACSD Dnll' [ ] level 3- ACSD Only
Total Square Footage: V:7~
Multiplied by Current Rate: Elem. $ / ./':2-;" $ 7t/.2,~
H.S. $ //~ = $ 71.2..Sh
Equals Total Fee: $ ~ ' ~ 'I = $/.~ I
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 automatically terminate and the appropriate City/County shall be notified.
Developer/Appiicant Signature:
Certification:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53 80 and 65995.
Date
ActU)lJcsfl
~naheim Union 'H.S. District
$
$
7~~~
7 t.jJ;;) ::.-Y;
Check No.
Check No.
I () ~.2
/0113
Distribution: City/CQunty - Developer - Accounting - Elementary District