122-128 W. Santa Ana St.
': J
5...~" Anaheim Union High .001 District
~. 501 Crescent Way, P,O. Box _ , Anaheim, CA 92803-3520
iiSii (714) 999-2188
'III (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 ,:ity or County as a condition of approvai for your project, and you
have received the requisite notice, the gO-day protest period began at the time your project was approved.
Receipt No: Elementary fJ(t's b High School District:
d3~~ Anaheim Union High School District
Owner Information: ~~:{P".1~::;i:::~~;J;;~l'~;:;;">
Name:
Address: ''".'':~- '2"i-"'ZZ:R""'~"'(J.,}'i' ..........':::fz:'{1.... ...... I
"""-"\"7'.:;:;:; .'......,.___,..' ........ "',,..,. - ',.' .. '. -..< .' .'.' ,', ,-, ,.' .",....'.".,."" ~It-J'~',;
Phone Number: L ) Ir{\:~~(': \~::~\. - ~-::r'-<tl--
I
Applicant Information:
Name:
Phone Number: (
~~~
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
0~
~
~
rjo Residential - New
] Residential - Room Addition
] Commercial
] Single Family
Multi-Family Condos/Apartments - # of units:
Equals Total Fee:
$
=$
=$
-$
Residentia'~
r ] Levell r ] Level 2" ACSD Ooly r ] Levei 3- ACSD Only
Total Square Footage: ,.;( '7, ';<;;;'<-0
Muitiplied by cur\-ent Rate: Eiem. $ /. f 2.- @/;t;oJ
H.5. $ 1/ ;;L-> - ~" '7k;,
Equals Total Fee: $ .:<,.;;? Y - $6SjQo,
commercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.5. $
Fee Waiver:
Fees Waived:
Yes
No
If yes, reason:
Acknowledgement:
The 'above representations 'as to square footage are true. Developer/Applicant agrees that ~f .it is later, determined that ,such.
representations are not true, Certificat hall auto leal y. erminate and the appropriate City/County shall be notified.
veloperjApplicant has paid school facility fees in compliance with Government Code
Developer/Applicant Signature:
Certification:
This certifies that the above nam
Sections 53080 and 65995.
/ :;;-!1ft/
Date I
/3o~~ ~~
Representative - Anahel Union HIgh School Dlstnct
Actu~~Sb
Anaheim Union H.5. District
$
$
3.;;( ,760. To
3,;( ?;;oJV
I
Check No.
Check No.
<I :J.- c/
'-/2':;::;.
"":_h:h..>;"n. r;t"lr,.,,,nh, _ n",vp]"npr _ Arrnllntina - Elementarv District