838 S. GILBUCK DR, BAnaheim Union High School District501CrescentWay,P.O.Box 3520,Anaheim,CA 92803-3520 RECEIVED
(714)999-5454
UNLIMITED
MAY 1 7 2022
CITY OF ANAHEIM
PLANNING a 3U:LD’\GCE-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 90-day protest period
began at the time your project was approved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District Ao1
OWNER INFORMATION:
Name: Address:ggij S.CA2
Phone Number:Home (Cell(
APPLICANT INFORMATION:
M/H
)sifp -
Name:3
Phone Number:Home (Ce(l(
PROPERTY INFORMATION:
S-GrilhlAcJ^^Project Address:
Development Type:()Residential'''^T^vv
()Single Famny
4 )Residential -Room Addition {)Commercial:
()Multi-Family Condos/Apartments #of units:
Project Name:
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
Elem.
RESIDENTIAL:
=$
Total Square Footage:
Multiplied by Current Rate
5 =$Elem.$
rl $=$H.S.
Equals TotalJedT?=$Equals Total Fee:$=$_
●fEE WAIVER:
^Fees Waived:{)Yes If yes,reason:
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true,Developer/Applicant agrees that if it is later determined that such respresentations
are not true.Certificate shall automatically termjp^e andjh^appropriate City/County shall be notified.
Developer/Applicant Signature:
7
Z
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
Repres'&Q;^tiVe -Anaheim Union High School DistrictDate
AaUAL FEES PAID:/
s v/YlpV *>:2-
Check No.
Check No.
9
Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department