1414 W BALL RD (2)Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
O
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 waslimposedbytheQtyorCountyasaconditionofapprovalforyourproject,and you have received the requisite notice,the 90-day protest periodbeganatthetimeyourprojectwasapproved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District
1
OWNER INFORMATION:
Name:
Address:
Phone Number:Home (7/^)
1/M2
Cell(
APPLICANT INFORMATION:
3 Name:fjM
Phone Number:Homef?/^)Cell(
PROPERTY INFORMATION:
Project Address:/-■V/A tJ^j Development Type:()Residential -New (>C)Residential -Room Addition
{7^Single Family
4
{)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 -i /.s ^7-^%'P^O V =s I
5 =s Elem.
$=$H.S.
Equals Total =$Equals Total Fee:$=$
mE WAIVER:
(Fees Waived:()Yes No If yes,reason:
ACKNOWLEDGEMENT:
iThe above respresentations as to square footage are true,Developer/Applicant agrees that if It is later determined that such respresentationslarenottrue.Certificate shall automatically terminate and the app^^riate City/County shall be notified.loeveloper/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.
8
Jt,
ReprgsentatjveN^nahetm Union High School DistrictDate
lACTUAL FEES PAID:
$Check No.
Check No.
3
$//-^-1lAnaheimUnionH.S.DIst.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department