1409 E. Santa Ana St.
.' :..~ Anaheim Union High SChool District
t.. ... . 501 Crescent Way, P.O. Box 3520, Anah~im, CA 92803-3520
. . ~.. (714) 999-2188 .
. . "Ill (714) 520-5741 FAX
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, ard you
have received the requisite notice, t~e JO-day protest period began at the time your project was apprc ....eo.
Receipt No: Elementary District: Higll School District:
c2 t.?3 'i? . ACSD Anaheim Union High School District
Owner Informatio=-m bu. e('> \Os-4'o I
Name: 0 ('(1) 'S
Address: 1<-(0'7 E :>a,,-+o... -A-niA :":--t-. ~n "p', (Y\ -
-~~"'-------'.,...
f'-JIl.\ lD'2.,c:;- '2,"-'\:27 .. ' . .. -. .- . - . - ..
Phone Number: ( )
Applicant Information: ~L rY\ e_
Nam.e:
Phone Number: ( ) .
. .
property Information: 1400 So.(\-h.~. 0~.~he;rY<
Address of Project: E.
, . .
Development Type: ( ] Residential - New . [ ~esidentlal. - Room Add~lon .. .. [; ] Commercial
) / .
ProJ~ct Name:
Type: ( .('Single Family ( ] Multi-Family Condos/Apartments - # of units:
Commercial: ~ Residential:
Total Square Footage: [ ] level 1 [ ] Level 2 - ACSD Only [ ] level 3- ACSD Only
~ -$ Total Square Footage: lol?~
. H.S. $. ~$ Multiplied by Current Rate: Elem. $ {.(;)... - $ 7(.8 .3~
Equals Total F . $ ~$ H.S. $ I. (d-. - $11.51 3.;\
EqualsTotal Fee: $ .::.l.,,). '-f - $ JS?'~ .r.<{
Fee Waiver: [ .t:o
Fees Waived: [ ] Yes If yes, reason:
Acknowledgement:
The above representatiOJ1s as to square footage are true. Developer/ Applic;mt agrees that if it is later determined that such
representations are not true, Certificate shall auto~IY terminate and the appropriate City/County shall be notified.
. ~ t 17 ..
Developer/Applicant Signature: y V~ _ ;rffiM~ ,;:;>
Certification: . .
This certifies that the above named Developer/Applicant has paid school faciJj~y _fees in compliance with Government Code
Sections 53080 and 65995.
~/~~/6S- Re~ ~ ~im Sfrfgh School DIStrict
,
Date .
Actual Fees Paid: . c.A- 1Z1
fK'-~'D $ rylo~.'6.J... . Check No.
Anaheim Union H.S. District $ 'J Io~, 3,.:l. Check No. ..,jL Lf.9D
..
Dlstnbutlon: CIty/County - Deve\Qper - Accountlfl9 - Elementary Dlstrr,ct
.~
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 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 gO-day protest period began at the time your project was approved.
Receipt.tlo:1' "c"
ifaJ..j'l (0/)
Elemen4~b .
High School District:
Anaheim Union High School District
Owner Information:
Name:
Address:
Phone Number:
~'. ...R~.e. Cl./".
...".... .... ........)o$/~.~..
. - . - --
)
Applicant Information:
Name:
Phone Number: (
~~~
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
] Residential - New
~~~
[)CJ Residential - Room Addition
"q
] Commercial
] Single Family
Multi-Family Condos/Apartments - # of units:
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.5. $
Equals Total Fee:
$
$
$
=$
Residential:
[ ] Level 1 [ ] Level 2 - ACSO Only [ ] Level 3- ACSD Dnly
Total Square Footage: / 1/ .
Multiplied by Current Rate: Eiem. $ /./'2/ _ $ loU/-.;[
H.S. $ /,'2/ _ $/~~"
Equals Total Fee: $ .;1( ,,;;( 'I - ~<f .(, <f
Fee Waiver:
Fees Waived:
Yes
] No
tZ,Idd:u-..d -%. A-,
If yes, reason: '/ .
~
O,,<L .
0<. lj3g
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 autom terminate and appropriate City/County shall be notified.
Developer/Applicant Signature:
Certification:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
~~d./-OS--
Date
Represe~-~im uni~ District
Act~ae~.:
Anaheim Union H.S. District
$
$
1.;2 c!.. .3 (l/
)';2..1; . a?-
Check No.
Check No.
97
Sl~
Distribution: City/County. Developer - Accounting . Elementary DJstrict