2620-2630 W. Madison Cir.
.~
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 90-day protest period began at the time your project was approved.
Owner Information:
Name:
Address:
Phone Number:
.3
)
,
High School District:
Anaheim Union High School District
Receipt No:
~1fy -
Eleme~ry ~istrict:
J7Ze .
Applicant Information:
Name:
Phone Number: (
d~
~~~
)
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
:SD
tV.
~.
,",
] Residential - New
Residential - Room Addition
] Commercial
] Single Family
[,xl
Multi-Famiiy Condos/Apartments - # of units:
~.
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.S. $
Equals Total Fee:
$
=$
=$
-$
Residential:
[ ] Level 1 [ ] Level 2 - ACSO Only J....] Level&- ACSO Only
Total Square Footage: (1 ~ V 6
Multiplied by Current Rate: Elem. $ /. 1'2-= $9:;,73. 7
H.5. $ //:v = ~.J,;73.7y
EquaisTotal Fee: $ ~.02 f = J~/</l.~ ;L
Fee Waiver:
Fees Waived:
Yes
[)(1 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 II automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
Certification:.
This certifies that the above named Deveioper/Applicant has paid school facility fees in compiiance with Government Code
Sections 53080 and 65995.
l{k2fIa~- ApJ. ~~
Date I I Representative _ Anah:;~nion High School District
A
$
$
'1'5"78. 7~
"1 ~-") ?5. 7~
r
Check No.
Check No.
1&-~7 1! '-f 2-23
1?j'77 :J-q22
.
DistributIon: City/County. Developer - Accountln9 - Elementary Olstrtct.