621 S WALNUT ST®tT>ZoZl -OMO^
Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
received
JUN 0 6 2022
UNLIMITED
CiTY OFAN’AHEiW
PLAN,\[.\'G i 3JiL0;.\G OEPARTWENTCERTIFICATEofCOMPLIANCE
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.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.;ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION:a
fa.l's ^(tVAor j-VYwenn U\^02<7/'/)/h^ii
Name;
Address:2
Phone Number:Home Cell(
APPUCANT INFORMATION:
Klo-yvi(ki
Phone Number:Home('
Name:3
c7/f^^<r-rjhr/Cell
PROPERTY INFORMATION:
Project Address;Iq,^\liVj\v\OV^^Z9i^2.Development Type:LAJ Residential -New ()Residential -Room Addition4 ()Commercial:
()Multi-Family Condds/Apartments #of units:(..-"^Single Family 0^h SProjectName:
COMMERCIAL:
Total Square Footage:
Muitipiled by Current Rate
Elem.^
RESIDENTIAL:
Total Square Footage:
Muitipiled by Current Rate
5 =$Elem.$
H.S.Cs.$=$
Equals TotaLFe^$=$Equals Total Fee:$=$_
FEE WAIVER:
Fees Waived:()Yes6 If yes,reason:
ACKNOWLEDGEMENT:^
The above respresentationsas to square footage are tru;
are not true.Certificate shall automatically termh
Developer/Applicant Signature:
er/Applicant agrees that if it is later determined that such respresentations
OpflatetnT^County shall be notified.7 and the aaor
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8 1 S:»\\&
RepreSerrtatiSre -Anaheim Union High School DistrictDate
ACTUAL FEES PAID:
A /1 )0 S$Check No.
Check No.
9
Anaheim Union H.S.DIst.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department